Download Trace Chemotherapy Waste/Pathological Waste

Spooner Health System
SUBJECT: 696 Disposal of Waste – HM-26
Current Revision: Oct. 2013
POLICY:
Personnel who handle and dispose of waste need to follow appropriate
guidelines. When handling infectious waste extraordinary precaution to
avoid splashing, spills or percutaneous injury and utilize the personal
protective equipment that is supplied.
AFFECTED PARTIES:
All Spooner Health System employees
WASTE CATEGORIES COVERED BY POLICY:
I.
II.
III.
IV.
V.
VI.
Regulated Medical Waste
Pathological Waste
Trace Chemotherapy Waste
Mercury Containing Materials
Solid Waste
Pharmaceutical Waste
DEFINITION AND CATEGORIES:
I. Regulated Medical Waste (Infectious) – Definition and Categories:
Infectious waste under Section NR500.03(67) Wis. Adm. Code, means solid waste
which contains pathogens with sufficient virulence and quantity so that exposure to
the waste by a susceptible host could result in an infectious disease. This is
considered “regulated medical waste” Isolation room waste will not be considered
infectious unless it meets the criteria listed below:
A. Regulated Medical Waste (Infectious)
1. “Microbiology lab wastes,” cultures, and equipment that have come in contact
with infectious agents.
2. Blood, blood products and body fluids.
3. Sharps – examples include, but are not limited to: hypodermic needles,
syringes, Pasteur pipettes, scalpel blades, glass slides, and cover slips.
4. “Regulated Medical waste” means waste or disposable equipment that is
contaminated with patients’ blood or body fluid or is saturated or “dripping”
with the fluid or that is caked with dried blood or other potentially infectious
material that are capable of releasing these materials during handling.
II.
Trace Chemotherapy Waste/Pathological Waste: (is accepted but must be
marked with yellow tag for incineration)
Date Printed: 9/24/2013
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Spooner Health System
A. Trace-contaminated Chemotherapy Waste-empty drug vials, syringes and
needles, spill kits, IV tubing and bags, contaminated gloves and gowns.
B. Pathological waste- Human tissue, body parts, organs, tissues and surgical
specimens.
III.
Hazardous Waste/Mercury Containing Waste
Chemicals: Formaldehyde, acids, alcohol, waste oil, solvents, reagents, fixer
developer, etc.
A. Hazardous Waste- Any container with a hazard warning symbol, batteries, heavy
metals, etc
B. Fixatives or preservatives
C. Radioactive Waste
D. Complete Human Remains
E. Bulk Chemotherapy Waste
F. Compressed Gas Cylinders, Canisters, Inhalers and aerosol cans
G. Glass thermometers
IV.
Solid Waste: All other waste not listed above. See attached table for examples (
table entitled Waste Segregation Guidelines)
V.
Pharmaceutical Waste (see chart below entitled Pharmaceutical Waste Streams):
A. Non-hazardous pharmaceutical-vials, tablets, IV bag/tubing containing labeled
medication, ampoules, oral medications
B. Incompatible pharmaceutical waste- inhalers, aerosols
C. Dual Waste- hazardous drug waste mixed with infectious waste
D. P-listed pharmaceutical waste-nicotine, warfarin (Coumadin), packaging of
nicotine and warfarin.
E. Sharps pharmaceutical waste- epinephrine (syringes and EpiPens), syringes with
needles, vaccine syringes, empty controlled substance syringes.
F. Bulk chemotherapy waste-chemo agents, containers with residue, chemo spill
cleanup, IV with residual.
G. Trace chemotherapy waste-empty chemotherapy vials, syringes, IV’s; gowns,
gloves, goggles, empty tubing and wipes.
H. Waste not accepted by Stericyle that needs to be disposed in the sewer systemmaintenance IV fluids, saline with bicarb, saline with KCl, lactated ringers, TPN,
controlled substances.
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Document: 696-HM-
Spooner Health System
PROCEDURE FOR HANDLING:
I. EQUIPMENT:
A. Gloves – located on wall of every patient room and in accessible areas of all
hospital departments that have the potential to handle blood/body fluids.
B. Gowns, aprons, face shields – located in clean utility rooms and appropriate
areas of other departments.
C. Red bags-For disposal of Regulated Medical waste
D. Red-bags with yellow tags for “incineration only”-For disposal of
chemotherapy/pathologic waste
E. Small bags- For disposal of solid waste small trash bins
F. Large bags-For disposal of solid waste large trash bins
G. Rigid sharps containers (Red)-For disposal of sharps
H. Rigid black container-for disposal of Rx hazardous waste, incompatible
hazardous waste, dual hazardous waste, P-listed pharmaceutical waste and
bulk chemo waste.
I. Rigid yellow container-for disposal of trace chemotherapy waste.
II. Regulated Medical Waste:
A. Regulated waste fitting the criteria listed above will be placed in a red bag prior to
being discarded in the lined, reusable barrels found in the soiled utility rooms.
Each bag will be securely tied so that it is leak proof. The barrel should only be
filled 2/3 to ¾ full so the liner can be tied. Do not overfill the barrel.
B. Sharps shall be contained in a rigid, puncture resistant container labeled
biohazard. These are located in every patient room and in designated areas
where needles are used. Nursing staff checks the rigid containers located in the
patient rooms on a daily basis. When the containers are 2/3 full, they shall be
sealed and transported upright as to preclude the loss of the contents. Do Not
recap, purposely bend, or clip needles by hand. Do Not remove the needle from
the syringe by hand. The outside of the container must be labeled biohazard or
have a visible biohazard emblem. These are then placed in the lined, reusable
barrels found in the soiled utility rooms. On a daily basis Environmental Services
will pick up the sealed containers and dispose of them in the locked outside
storage facility until picked up by the licensed hauler.
C. The soiled utility rooms are marked by a biohazard symbol and the door will
remain closed at all times.
D. Containers of blood or body fluids: Using gloves and a face shield or fixed
protective shield, pour bulk blood, suctioned fluids, peritoneal dialysis fluid,
excretions and secretions CAREFULLY down the sanitary sewer. Sanitary
sewers may also be used for the disposal of other infectious wastes capable of
being ground and flushed. Once emptied completely, containers from the above
fluids may be disposed of in the regular trash. If such containers are unable to be
emptied safely, discard as the other regulated waste with equal amounts of a
solidifier or absorbent toweling.
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Spooner Health System
III. Chemotherapy/Pathological Waste:
A. Must be placed in a red, leak-proof bag with sufficient strength to prevent tearing
or bursting under normal conditions. These containers are double-bagged and
flagged with yellow tag marked “for incineration only”. If body fluids are
present, equal amounts of a solidifier or absorbent toweling must be present.
B. Women’s Health/Surgery: Handling of placentas: Put a clean peri-pad in the red
bag with the placenta to absorb any excess blood and then place it in a zip lock
bag and seal, prior to refrigeration. The peri-pad may be substituted by wrapping
the placenta in a blue pad prior to placing it in a red bag.
IV. Solid Waste: Dispose of in clear or gray plastic bags.
VI. Hazardous Waste/Mercury Containing Waste:
A. Until the regulated medical waste is hauled away by a licensed hauler and
treated, it shall be segregated and contained in the outside storage area. Spill
kits are available at bulk storage locations.
C. If an exposure occurs, follow the procedure in the Infection Control located on the
Intranet. Policy search “needle stick”
D. Each department is responsible for packaging and securely sealing their
infectious waste. It is then removed daily or more often if requested by
department, by Environmental Services and stored in the outside storage area
until off-site removal by a licensed hauler.
VII. Pharmaceutical Waste: All pharmaceutical waste is disposed of as outlined
on the chart below (Pharmaceutical Waste Streams)
A. Spooner Health System is by definition a small time user of pharmaceutical PWaste. This means that the amount of P-waste disposed of at one time cannot
exceed 2.2 pounds each month. Pharmacy personnel will track and
subsequently log P-waste on a monthly basis.
B. A medication-containing container is considered empty if it contains 3% or less
by volume. Empty glass containers will be stored separately for disposal and
labeled “glass”. Environmental Services will pickup when needed and dispose of
the empty glass containers as solid waste.
C. Contact environmental services when pharmaceutical waste containers are in
need of pickup and removal to a waste storage area.
Date Printed: 9/24/2013
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Document: 696-HM-
Spooner Health System
Pharmaceutical Waste
Sharps
Chemo Waste
(Bulk &Trace)
• Vials
• Nicotine
• Tablets
• Coumadin / Warfarin
• IV Bag/ Tubing
Containing
Labeled Meds
• Packaging-Nicotine,
Coumadin/ Warfarin
• Black Labeled Rx
Spill Cleanup
Hazardous Drug Waste
mixed with Infectious
waste:
• Non-expunged syringe
with hazardous
pharmaceutical
• IV’s with Blood Backup
• Ampules
• Oral
Medications
Without Physical
Labels
Sharps must
be empty
before
disposal into
sharps
container
• Epi
Syringes
• Epi Pens
• Syringes
with
Needles
• Non-Compatibles
•Chemo
Agents
“Incompatible”
BLACK Haz
Waste
Container
Date Printed: 9/24/2013
26
- Saline w/
Bicarb
• Chemo
Spill
•
Cleanup
•
• IV w/
Residual
•
TRACE
Empty Vials
Empty
Syringes
IV’s – Empty
and
Backflushed
• Gowns
• Gloves
- Saline w/
KCl
- Lactated
Ringer
- TPN
• Controlled
Substances
(Follow DEA
Rules for
Disposal)
• Goggles
• Tubing –
Empty and
Backflushed
Pharmacy
“Rx”
BLACK
Haz
Waste
Container
- Saline
• Containers
w/ Residue
• Empty
Controlled
Substance
Syringes
• Bag up/Bag down
• Maintenance
IV Fluids
BULK
• Vaccine
Syringes
• Inhalers
Sewer
System
• Wipes
“Dual Waste”
BLACK
Haz
Waste
Container
“P-Listed”
BLACK
Haz
Waste
Container
Sharps
Container
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Bulk
BLACK
Chemo
Container
Trace
YELLOW
Chemo
Container
Sink or
Toilet
(Sanitary
Sewer)
Document: 696-HM-
Spooner Health System
Date Printed: 9/24/2013
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Document: 696-HM-
Spooner Health System
Waste Segregation Guidelines
REGULATED MEDICAL
WASTE
(Infectious)
CHEMOTHERAPY/
PATHOLOGICAL
WASTE
Chemotherapy Sharps
Container or Bag
Red Biohazard Bag
Blood/blood products &
OPIM - Examples:
SOLID WASTE (TRASH)
Examples:
 Paper & plastic wrappers,
packaging, boxes,
computer paper, office
waste

Gowns


Gloves
Containers,
catheters, or tubes
with fluid blood or
blood products not
discarded or flushed
i.e., blood sets,
suction canisters &
drainage sets (If not
emptied, need
adequate absorbent
material in
container)

Masks

Barriers

IV tubing

Empty bags/bottles

Empty drug vials

Spill clean-up materials
or kits

Dialyzers & tubing

HEPA filters from
Pharmacy laminar air
flow hood

Blood spill clean-up
materials

Saturated or grossly
soiled disposables,
i.e., bloody gauze,
dressings, lap pads,
OB and surgical
peri-pads & gloves
Hazardous Waste
Container
Clear Bags
Trace-contaminated items
generated in the preparation
& administration of
antineoplastic/cytotoxic
drugs - Examples:

HAZARDOUS WASTE
Unused medical products
& supplies

PPE (worn, but not
soiled)

Food products & waste
(soda cans, paper cups,
plastic utensils)

Empty IV bags, bottles &
tubing without needles

Empty urine cups, stool
containers, Foley
bags/tubing, diapers, chux

Exam & cleaning gloves

Empty collection bottles
& bags

Sanitary napkins &
tampons (personal)
Examples:
 Outdated/unused
chemotherapy drugs
(bulk)

Certain pharmaceuticals

Mercury-filled devices,
batteries, thermometers,
& blood pressure cuffs
& gauges

Used solvents, stains,
paints, & thinner

Chemicals such as
formaldehyde &
formalin, acetone,
toluene, mercury
fixatives, barium,
xylene, alcohol,
disinfectants &
chemical sterilizing
agents

Drums or other
containers with
"hazardous" label

Radioactive material
Sharps Containers











Needles & syringes
Scalpel blades & lancets
Glass pipettes & tubes
Culture slides & dishes
Broken contaminated
glass
Broken rigid plastic
Staples & wires
Disposable suture sets &
biopsy forceps
Electrocautery tips
Cardio-catheter wires
Needles & syringes

Disposable paper drapes,
lab coats, paper towels,
band aids

Disposable basins,
bedpans, urinals

Non-mercury batteries

Empty aerosol pressure
cans
Pathological Waste






Placentas
surgical specimens
Human tissue
Body Parts
Organs
Tissues
For additional information, please see Hospital Infection Control Manual IC Infectious Wastes-Disposal of.
Revised October 2004 , March 29, 2005
Date of
Printed:
9/24/2013
Compliments
Stericycle,
Inc.
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Document: 696-HM-