Medical Waste. Laurie Tenace Florida Department of Environmental Protection. SQG/HHW Workshop April 2003

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Vivian Gibson
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1 Medical Waste Management Laurie Tenace Florida Department of Environmental Protection SQG/HHW Workshop April 2003

3 WHO Hospitals... Clinics Veterinarians Dentists Blood Banks Laboratories And each with its own waste problems!

4 WHAT - 4 waste streams possible Solid Waste C&D at many facilities lots of recycling opportunities food waste Biomedical Waste (regulated medical waste, RMW, red bag waste) Hazardous Waste (pharmaceutical waste is a subset) Low Level Radioactive Waste Mixed wastes are a problem

(regulated medical waste, RMW, red bag waste) Hazardous Waste

5 MIXING WASTE STREAMS Solid + Hazardous = Hazardous Solid + Biomedical = Biomedical Solid + LLRadioactive = LLR Haz + Biomed = render nonbiomedical, then treat as Haz Biomed + LLR = see above Haz + LLR = really bad stuff!

= LLR Haz + Biomed = render nonbiomedical, then treat

6 What types of waste might you see? Total Waste Comp solid waste 85% hazardous waste 5% potentially infectious waste 10% Metal 10% Food 10% Solid Waste Comp Other 10% Glass 7% Wood 3% Paper & Cardboard 45% Plastics 15% (ASHES. An Ounce of Prevention )

infectious waste 10% Metal 10% Food 10% Solid Waste Comp Other

7 WHERE All over the facility Plant operations Facilities management Laboratories Imaging Offices all departments - ER, OR, ICU, CCU, ICCU, OB, Cardio, Onc, Endo, etc

8 What about SQG s? Day Stay Clinics - OR waste Independent Labs - any lab waste Veterinarians - smaller quantities of anything a big hospital generates Dental offices - mercury & x-ray waste

9 WHEN any time of day - open 24/7/365 night deliveries, emergencies, restocking all day, You get the Picture! (Apalachee Bay near Panacea)

10 How can we help?

11 FLORIDA DEP IS (ARE?) CHAMPIONS!

12 H2E Resources Our Waste, Our Responsibility video Environmentally Preferable Purchasing Guide Solid & Chemical Waste Minimization Plans Mercury Elimination Plan

13 More resources Environmental Accounting Guidance Best Practices Tool Awards and Recognition Resource Directory Available on the H2E website:

14 FACTOID US hospitals produce 6600 tons of waste per day! Healthcare Institutions that have engaged in full-fledged waste reduction have saved 40-70% waste in management costs.

15 Add H2E web site shot when internet comes back!

16 Who regulates them? DEA, FAA, OPOs, SEC, IRS, EPA, FTC, FCC, HHS, HRSA, NIOSH, JCAHO, NRC, DOL, FBI, DOJ, OSHA, DOT, FDA, OIG, PROs, PRRB and on the State level: Survey & Certification, Courts, Attorneys General, Medicaid, Health Boards, Medical Boards, Local Governments, Licensure

17 What do they want? To practice safe medicine! To comply with all of us To avoid lawsuits To have good community relations To save/make money

18 How are hospitals organized? VARIES! Departments Hospital Groups small or large private, public, non profit, for profit, university, etc. group purchasing organizations (GPOs)

19 What about smaller facilities? May be part of a group local national hospital group Independent Own/rent building? Who deals with their waste?

20 Who Manages the Waste in the Facility? Varies! Environmental Services may do solid waste and biomedical waste Lab may do hazardous waste X-ray may do the low-level radioactive Infection Control - training, in-services May wear many hats You may need 2-3 contacts

Lab may do hazardous waste X-ray may do the low-level radioactive

21 Where does their waste go? Varies! Recycle Landfill Send biomed off for treatment or treat on site Ship haz waste May incinerate on site (only 15 hospitals still incinerate in FL)

22 Rotoclave grinds, chops, & autoclaves waste Finished material

23 On-Site Incineration And other on-site treatment chemical sterilization microwaving heat radiation

24 SOLID WASTE H2E provides lots of great recycling ideas HIPAA is newest concern - privacy of hospital records

25 Locking Paper Bin

26 BIOMEDICAL WASTE Definition: few understand it! Fewer follow it! Big headaches! DOH regulates in Florida - contact Edith Coulter or Ed Golding at (850)

27 How is Biomedical Waste Regulated? Chapter 64E-16, F.A.C. Biomedical Waste / Body Piercing Coord.s listing Permitting: Biomedical Waste Generator Biomedical waste Storage Facilities Sharps-collection Programs Biomedical Waste Transporter Facilities for the Commercial Treatment of Biomedical Waste

29 Sharps Collection Programs 33 Counties already have programs some are run out of HHW programs DOH is hoping to get more money for more county programs

30 types of haz waste you might encounter: Varies! Both quantity and kind facilities management lab waste Who s managing it?

31 HAZARDOUS WASTE solvent waste - largest quantity lab - may distill - xylene and/or alcohol some facilities management cleansers, degreasers, etc. MSDS vs COA

34 Other Lab Waste

35 MERCURY (my favorite!) Where? Three largest quantities: Sphygmomanometers (blood pressure devices) Endoscopy equipment Thermometers (not common anymore)

36 SPHYGMOMANOMETERS

37 Endoscopy Equipment

38 Thermometers

39 Other Sources

40 LOW LEVEL RADIOACTIVE WASTE Not Our Problem regulated by NRC (Nuclear Regulatory Commission)

41 However, x-ray waste IS our problem Waste Streams: Waste Film Waste Developer Waste Rinse Water Waste Fixer

42 X-Ray WASTE Film = Plastic + Silver* *As a Silver Halide e.g. Silver Chloride or Silver Bromide Silver - Small Amounts may be regulated by sewage treatment plant. 5mg/L (ppm) or more = Haz Waste (Thanks to Tom Waters who I blatantly plagiarized)

43 X-Ray Waste When the film is processed to expose the image, a portion of the silver is removed from the film. X-ray dip tank

44 Scrap X-ray film Who s that? Contains silver Is not usually regulated. Recommend collecting & shipping for recycling.

45 X-Ray Rinse Water May contain small amount of silver. Not regulated as a hazardous waste - as long as it contains < 5 mg./l (PPM) silver. * May be allowed to discharge to municipal sewer - check with municipality, first.

46 Waste Developer May contain small amount of silver. Not regulated as a hazardous waste - as long as it contains < 5 mg/l (PPM) silver. May be allowed to discharge to municipal sewer - check with municipality, first. May want to have picked up. * Do NOT discharge to septic tank.

47 Waste Fixer Most of the silver removed from the film during processing is in the fixer as a soluble silver thiosulfate complex. Normally contains > 5 mg/l (PPM) Silver. Usually meets criteria of a Hazardous Waste.

48 Waste Fixer Disposal Options Have picked up by a Haz Waste Transporter. If CESQG - have picked up by other company for proper treatment. * On site Silver Recovery - check with municipality, first

49 Fixer and Developer Fixer Developer Haz Waste Non-Regulated Waste

50 On-site Silver Recovery Small Silver Recovery Cartridge In-Line Silver Recovery Metallic Replacement Pail Electroplating & Metallic Replacement Units in Line

51 Dental Waste Part of dental film packets to inhibit scatter radiation. May be a Hazardous Waste due to lead. Dispose of through one of the special recycling programs for lead foil.

52 Dental Waste - Amalgam silver fillings are 50% mecury BMPs, list of recyclers available City of Palo Alto, CA campaign

53 PHARMACEUTICAL WASTE Come to the other program! 2:45 and 4:00 Wednesday

54 Technical/Compliance assistance available H2E FDEP - call me or P2 people: Michael Ohlsen (850) Aprilia Graves (850) Rainier Viera (850) sheet of web sites available

55 EPA 233-B

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