CHS Medical Group Hazardous Waste Management In Service

CHS Medical Group Hazardous Waste Management In Service

Objective Educate staff how to properly manage Regulated Medical Waste (RMW), Chemotherapy Waste and EPA RCRA Hazardous Waste Ensure compliance with Federal, State and local regulations. 5/19/2015 2

Regulated Medical Waste Management 5/19/2015 3

Types of Regulated Medical Waste Sharps Waste Used hypodermic needles, syringes, scalpel blades, Pasteur pipettes, broken glass and similar devices likely to be contaminated with organisms that are pathogenic to healthy humans and all sharps used in patient care (glass medication/vaccine vials, tubes, plates/culture dishes). Other Potential Infectious Materials (OPIM) - Any waste material with the presence or reasonably anticipated presence of blood or infectious material. Or any waste material containing or contaminated with liquids of human or animal origin, but not including urine. Pathological Waste animal carcasses, organs, tissues, body parts other than teeth, products of conception, and fluids removed by trauma or during surgery or autopsy or other medical procedure, and not fixed in formaldehyde. Trace Chemotherapy Waste Is when there is less than 3% of the chemotherapy drug remaining in infusion bag/bottle after the administration of chemotherapy pharmaceuticals. Trace chemo waste include but not limited to the following: Barriers, Personal Protective Equipment, infusion bags/bottles, IV tubing, drug vials, etc. Also non-rcra full or partial chemotherapy drugs can be disposed of in the Yellow Chemo container. 5/19/2015 4

Examples of Items for Disposal in Sharps Containers Please remove patient identifiers prior to disposal. If the medication is an EPA RCRA drug please dispose of according to CHS Waste Disposal Guidelines. 5/19/2015 5

RMW Packaging Containers containing regulated medical waste liners (red bags) are defined by Department of Transportation (DOT) as a secondary container. Regulated medical waste must be bagged prior to placement into the secondary container. Free liquids must have enough absorbent included during disposal shipment in the event of a biohazard spill during transportation. When placing sharps containers in secondary containers ensure box is lined with a red bag. Ensure proper packaging prior to signing the waste manifest. Trash should be disposed of separately in regular trash receptacles and not in red bags. 5/19/2015 6

RMW Proper Management How to tie biohazard bags Properly tied knot Once properly tied, place in appropriate biohazard container 5/19/2015 7

Hey Did you Know??? RMW Improper Disposal Improper Disposal of EPA RCRA Hazardous Waste can cause a penalty of $37,500 5/19/2015 8

Chemotherapy Waste Management 5/19/2015 9

Chemotherapy Waste Management Trace Chemotherapy Waste Contains less than 3% of the original content of chemotherapy agent by weight if a RCRA chemotherapy drug Full/Partial bags or bottles of Non-RCRA chemotherapy drugs Consists of: Vials Containers Needles Tubing Gloves & Gowns Bulk Chemotherapy Waste EPA RCRA Chemotherapy drug containing more than 3% of the original content of chemotherapy agent by weight Is considered hazardous and must be disposed of as RCRA waste. Consists of: Partial/full bags of drugs Partial/full bottles of drugs Trace chemotherapy waste should be placed in yellow waste containers for disposal Bulk chemotherapy waste should be placed in black RCRA waste containers for disposal 5/19/2015 10

Chemotherapy Waste Management Chemotherapy Agents with special disposal requirements: There are eight chemotherapy agents that are RCRA U-List Hazardous Waste: Chlorambucil (U035) Cyclophosphamide (U058) Daunomycin (U059) Diethylstilbestrol (U089) Melphalan (U150) Mitomycin C (U010) Streptozotocin (U206) Uracil Mustard (U237) There are two P-List Chemotherapy agents: Arsenic Trioxide (P012) Physostigmine (P204) Other listed chemicals used in Cancer Research for treatment and trial drugs: Azuserine (U015) Chlornaphazin (U026) Ethyl Carbamute (U238) 3-Methylcholanthrene (U157) 5/19/2015 11

EPA Resource Conservation Recovery Act (RCRA) Hazardous Waste 5/19/2015 12

Examples of RCRA Waste Isopropyl Alcohol (Any alcohol with a concentration 24% or greater) Chloroprep* Pharmaceuticals (Warfarin, Coumadin, Nicotine, Lindane, Silvadene, etc. see CHS Disposal Guide for listing). Silver Nitrate Swabs* Barium Sulfate* Hydrogen Peroxide Note: * indicate that these materials are not considered RCRA waste if materials were utilized for their intended purpose 5/19/2015 13

Reverse Distribution (EXP) Hazardous Waste should not knowingly be sent to EXP as a means of disposal. The intent of sending product/materials to EXP is for the product to be reused or reworked back into formulary. Note: only unopened expired items should be sent to EXP. Don ts Do not send unknowns to EXP. Do not send partial aerosols or inhalers to EXP Do not sent partial bottles of Alcohol or Hydrogen Peroxide to EXP Do s Send known items. Send items in original packaging. Send outdate/unused items. 5/19/2015 14

Container Management Guide Hazardous Waste Regulated Medical Waste Sharps Waste Pharmaceuticals/Chemicals on the RCRA List (see FSO if you don't have list) Items Saturated with Blood or OPIM Glass - contaminated culture bottles, blood tubes, broken glass, broken ampoules Coumadin items and wrappers Blood/product bags with IV tubing Syringes, with or without sharps Nicotine items and Wrappers Xylene in bottles Formaldehyde solutions > 37% in bottles Solvents with flash point <140 F in bottles Liquids with a ph <2 or > 12.5 in containers Hydrogen Peroxide solution in bottles Ethanol in bottles Aerosol cans (NOT fully empty/at zero pressure) Chloroprep (unused) Alcohol solutions > 24% in bottles Hemodialysis blood and artificial kidney tubing Suction canisters, chest tubes, etc containing bodily fluids (add solidfier when >25ml liquid in container) Pathologic Waste (Tissues, organs, body parts and animal carcasses) - red bin with yellow pathologic waste label Surgical staples and staplers Suture needles Surgical blades Sharp disposable instruments Compressed calibration gas cylinders, place into plastic container, keep separate from other hazardous waste (see CHS Waste Guide for more info) 5/19/2015 15

Container Management Guide Oncologic/Chemo Waste Trash Sewer Chemotherapy, oncologic, cytotoxic and NIOSH pharmaceuticals that are NOT ON THE RCRA LIST See CHS Chemo/Hazardous Agent Policy 5.12 for more information on hazardous pharmaceutical handling & disposal Gloves, masks, PPE, bandages, items NOT Saturated with blood or OPIM Catheters and drainage devices (Empty) Suction canisters (Empty) Urine Blood Feces Material Soiled with urine, feces from chemo patients -- must go into orange chemo linen bag IV Bags and tubing Formalin at 10% solution Chest tubes (Empty) Cidex/Cidex OPA (new/used) Urine dipsticks Glucose test strips Throat swabs Solid waste/non-regulated waste Aerosol Cans - Fully empty Used Chloroprep Alcohol wipes Alkaline Batteries 5/19/2015 16

RCRA Waste Disposal Process To Have RCRA waste removed and disposed: Complete a Chemical Pickup Request e-form located on PeopleConnect under eforms. Chemical Pickup Request e-form should be completed when container is approximately ¾ full. Submit completed Chemical Pickup Request e-form. Once the completed Chemical Pickup request e-form is received, Corporate Safety will facilitate the removal and disposal of waste from the practices. Keep in mind that due to pick up route availability and regulations a practice may be required to store the waste for up to six months. 5/19/2015 17

Chemical Pickup Request form 5/19/2015 18

CHS Training Tools/Resources Available U.S. Department of Transportation Training (Medical Group) CHS Waste Disposal Guide located on Corporate Safety Site on Peopleconnect CHS Policy 5.11 ACE Module RCRA Hazardous Waste Training (Awareness) CHS MG Waste Management Summary located on CHSMG Safety SharePoint site 5/19/2015 19

For Questions Contact: Corporate Safety Environmental Compliance Division 704.512.7283 Or CRPSF@carolinashealthcare.org 5/19/2015 20