Sharps Management and Other Strategies for Proper Handling of Medical Waste. By Jack McGurk, President Systems Improvement Initiators, Inc (Si 3 )

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1 Sharps Management and Other Strategies for Proper Handling of Medical Waste By Jack McGurk, President Systems Improvement Initiators, Inc (Si 3 )

2 Talk Objectives! Improved understanding for compliance with Medical Waste Management Act from a small quantity generator perspective! Learn some strategies for more effective and cost-efficient management of sharps waste! Obtain an improved awareness of pollution prevention strategies

3 Medical Waste! Defined as being composed of:! Biohazardous Waste! Sharps Waste! AB 2335 recently signed by the Governor adds Biosafety Levels II IV organisms to the definition of medical waste

4 Medical Waste Update! Stericycle is the major hauler! Treats approximately 95% of medical waste generated in the state! No commercial medical waste incinerators in the state! Waste requiring incineration must be sent out of state! New Technologies:! InEnTec developing Plasma Arc treatment! MedServe takes treatment to healthcare facilities

5 Impact to Small Quantity Generators! Must look at most economical means to handle small quantities of medical waste! Avoid stop charges for non-scheduled routes! Awareness of new state fees charged to treaters and passed along to generators! The Act allows increased storage times for SQGs! Managing the small quantity waste stream is important

6 Helping Healthcare Facilities to Comply With the Medical Waste Requirements! Self-Assessment Manual and Inspection Tool! A tool for evaluating your medical waste practices for compliance! A Safe Harbor approach to solving problems with the local enforcement agency! Reduce the likelihood of violations! Use the tool to train staff! Consultation services from some regulators! DHS website:

7 Three Problems Impact Worker Safety! Suction Canister Treatment! Must be adequate to protect staff! Must be adequate to protect landfill workers! Sharps Containers! Reusable sharps containers protect workers! Reduce the waste stream! Home-Generated Sharps! Must protect landfill workers & communities! Mailback sharps containers

8 Suction Canisters! Used within hospitals! Can create spill problems! Pouring creates aerosol problems! Several methods used to treat them! Solidifying! Treatments found not to be efficacious! Autoclave! Did not treat adequately the solidified canisters! Autoclave non-solidified canisters at higher temperatures

9 Suction Canister Autoclave Treatment Study

10

11 Suction Canister Testing Temperature (F) Autoclave 50/50 Serum/Saline 100% Serum 100% Saline 50/50 w / Gel Saline w / Liner & Gel Elapsed Time (min)

12 Testing of Five Solidifiers! No significant performance difference in temperature penetration of canisters solidified by various brands! 30-minute autoclave exposure to F resulted in internal temperature range of F F, well below the F needed to ensure treatment of the waste inside the canister

13 Microbiological Testing! Significant risk is taken if biological indicators are not used to validate the autoclave treatment! G. stearothermophilus spores on strips contained in glassine envelopes stapled to tongue depressors were placed in the center of the suction canisters! Analysis run in a state-certified laboratory

14 Microbiological Test Results! 20 suction canisters containing liquid were treated and 8 (40.0%) tested positive at an off-site treatment facility! Four non-autoclavable canisters treated at F for 30 minutes; internal temperatures reached F successfully killed the spores! Off-site treatment companies were directed by DHS to test their autoclaves. Most will run their autoclaves at higher temperatures 300+ degrees! Customers will be directed to segregate solidified canisters for incineration treatment

15 Microbiological Test Results! 24 of 25 (96.0%) suction canisters with their contents solidified did not reach adequate internal temperatures to kill the spores! Two of these samples were run in autoclavable canisters for 90 minutes and failed to kill the spores! One of the two was treated at F! Solidified canisters will need to be segregated for incineration

16

17

18 Canister Using Removable Liners

19 Engineered Controls

20 Engineered Controls

21 Engineered Controls

22 Reusable Sharps Containers! Medical waste stream can be significantly reduced by utilizing reusable sharps containers! One study of a 250 bed hospital indicated that: 18,000 sharps containers were used annually Removing them would reduce the medical waste stream by 13 tons

23

24 Home-Generated Sharps The Problem! Millions self-inject! 3 billion needles generated annually! Most disposed of improperly! Children and public sector workers at risk

25 Sharps Include! Hypodermic needles and syringes! 9 million legal self injectors (3% of population) in the U.S! 3 billion needles/yr outside health system annually! Most needles disposed in trash, public or commercial settings

26 Response to the Problem! Recognized problem! Risk to workers! Risk to communities! Funded (with BD and Sharps Compliance) Coalition for Safe Community Needle Disposal to build consensus for solution

27

28 Solutions - Limited Options! Old EPA guideline: sealed container in trash! New EPA guideline: remove from waste stream! Drop box/collection sites! Mail-back! Syringe exchange programs! At-home needle destruction! EPA guideline sets state & local policy

29 New EPA Guidelines

30 EPA Brochure - Self-injectors

31 One Solution! The Sharps Disposal-by-Mail TM System! A partnership of Waste Management, Sharps Compliance and Becton Dickenson

32 How the Program Works! Residents pick up containers at participating pharmacies! Fill containers with used sharps! Mail containers to Sharps Compliance, Inc. in postage prepaid mailing box

33 How the Program Works! Pharmacies will bill through RxWest! RxWest will bill Waste Management at periodic intervals! Waste Management will pay from funds collected for this service in contract! Reports available through RxWest

34 Residential Benefits! Easy to use! Self-directed program! Confidential! Protects family and community! Distinguishes community as a proactive leader

35 Microfiber Mop System " Helps in infection control by using one cloth per room " Ergonomically effective " Saves time

36 " Uses less chemicals " Uses less water " Mopping cloth lasts longer than mops " Light weight, makes it easy to use 90 % reduction in water and Chemicals used

37

38 Further Assistance Contact Jack McGurk Systems Improvement Initiators, Inc. (Si 3 ) (916) or Cell (916) jackmcgurk@aol.com

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