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Medical Waste and Other Hazardous Substances Including Cleaning Materials

Solid waste is a high cost area of hospital and other healthcare facility expenses. The solid waste has to be divided into normal solid waste produced by various businesses including considerable paper and paper board, plastic, glass, food remnants, and medical waste and other hazardous substances. Utilize programs of minimization and pollution prevention including source reduction, recycling, and better use of materials to help reduce the overall solid waste problem and save considerable money for the institution. The majority of this discussion will be on medical waste and other hazardous substances.

Infectious waste is produced in patient care areas, laboratory areas, and research areas and consists of a variety of disposable materials including parts of equipment which have come in contact with the infected patients. Sharps include needles, scalpels, and sharp pieces of broken objects, especially plastics and glass. Major medical waste includes: cultures and stocks of microorganisms from laboratories; bulk blood, blood products, and bloody body fluid; pathology and anatomy wastes such as human tissue, and body parts; and contaminated materials from highly infectious patients.

Pharmaceutical waste includes materials contaminated by pharmaceuticals, expired pharmaceuticals, and liquids which have come in contact with the pharmaceuticals. Pharmaceutical waste is a concern because pharmaceutical residues have been found in drinking water in major metropolitan areas serving large numbers of people. Human and veterinary drugs, both prescription and over- the-counter, even at very low concentrations, may cause a risk to sensitive populations such as the fetus, individuals with chemical sensitivities, and individuals with existing diseases taking large numbers of prescribed pharmaceuticals. Hormone-disrupting chemicals may be a particular challenge to the fetus and young children at very low levels.

Chemical waste includes a vast variety of materials from laboratories, housekeeping cleaners and disinfectants, and chemicals used in swimming pools and hydrotherapy. Research waste includes animal carcasses, various containers, and testing media. Special waste containing heavy metals includes batteries, thermometers, certain chemicals, etc. Pressurized containers include empty gas cylinders, gas cartridges, and aerosol cans. Radioactive waste containing radioactive material from therapy or research laboratories includes contaminated glassware and other containers, urine and feces from patients receiving radioactive therapies, and unused portions of the radioactive material. Chemicals used in cancer treatment can damage the cells or genes.

Hospitals primarily used to take care of their own medical waste and other hazardous substances. Before 1995 there were over 4000 medical waste incinerators in the United States. They produced in addition to many other toxins, dioxin and mercury, which ended up in the air and water.

Today this has been reduced substantially and much of the waste is now sent to specialized treatment companies who can carry out proper shredding and incineration with appropriate air pollution controls and water pollution protections. The generation and transportation of medical waste and other hazardous substances is of greatest concern in the occupational environment, and therefore all employees must take necessary precautions to avoid becoming contaminated and ill.

Best Practices for Medical Waste and Other Hazardous Substances including Cleaning

Materials plus General Solid Waste (See endnote 4) (See Chapter 12, “Solid Waste, Hazardous

Materials, and Hazardous Waste Management”)

  • • Place all medical waste and other biohazardous substances in special containers which are then double bagged and specially marked as highly infectious material, and collect it separately from other waste materials.
  • • Put all sharps in puncture-proof and leak-proof containers which are specifically marked as such and marked as highly infectious material.
  • • Use the international infectious substances symbol on all infectious waste.
  • • Sterilize by autoclaving all microbiological laboratory waste in a special autoclave used only for contaminated materials prior to disposal.
  • • Cytotoxic waste must be placed in hardened leak-proof containers, labeled cytotoxic waste, and moved to specialized approved medical incinerators by trained individuals.
  • • Chemical waste must be packed in special chemical-resistant containers, appropriately labeled, and removed to specialized treatment facilities for hazardous chemicals.
  • • Use steam sterilization for all sharps, disposable syringes, IV sets, catheters, and various tubing used in the body and then shred them and place them in a landfill in a deep burial secure area above the groundwater table.
  • • Incinerate all body parts unless there is a religious requirement to bury them.
  • • Incinerate all animal carcasses used in research areas.
  • • Exclude all contaminated plastics from incineration and use steam sterilization prior to shredding and land disposal.
  • • Use steam sterilization for all highly infectious patient wastes contaminated with body fluids, excretions of all types, as well as infectious laboratory waste prior to incineration.
  • • Determine when to use disinfectants in order to limit chemical exposure by personnel and patients.
  • • Determine if new cleaning technologies such as peroxide vapor and steam vapor are both effective in disinfecting contaminated areas and also cost-effective.
  • • Conduct appropriate research to determine at what level pharmaceuticals in water may become a health problem to various subpopulations of people and what levels of pharmaceuticals are typically found in the water supply.
  • • Determine the amount of waste anesthetic gases released into the air and whether or not they have a negative effect on personnel.
  • • Develop and enforce stringent air pollution rules and regulations for use of hospital medical incinerators.
  • • Determine if thermal treatment such as the use of microwave technologies will destroy microorganisms that can cause disease.
  • • Despite the expiration of the Medical Waste Tracking Act of 1988, record medical waste generation from starting point to final resting place, and determine if all necessary preventive techniques have been utilized to protect workers.
  • • Inform all workers of the nature of the hazardous waste being transported and proper means of self-protection.
  • • Train all workers in the proper handling of hazardous medical waste and provide appropriately trained immediate supervisors to evaluate the operations, make necessary corrections, and keep proper records.

Noise

(See endnote 6)

Noise is excessively high in hospitals. There are numerous noise sources which are allowed and disturbing including public address systems, alarms, telephones, voices of personnel, other patients, equipment being moved back and forth in the hallways, bed rails, etc. The various surfaces which may be excellent for cleaning typically bounce sound off of floors, walls, ceilings, and various pieces of equipment. The sound-reflecting surfaces cause the sounds to echo and overlap each other for long periods of time. Studies have shown that medical equipment and staff voices can produce 70-75 dB of sound at the patient’s ears, which is equivalent to the noise level in a busy restaurant. Noises from alarms and certain equipment can produce 90 dB of sound, which is equivalent to the noise produced next to a highway.

High sound levels or noise can affect the health of individuals. Noise can decrease oxygen saturation, elevate blood pressure, increase the heart and respiration rate, and interfere with sleep. Frequent and sudden awakening can be detrimental to the patient. Stress levels especially in adults increase and healing is delayed when noise levels increase.

 
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