Medical Waste

(See endnotes 40, 42, 43, 44)

Medical waste is material or bodily fluids which are potentially contaminated and may be involved in the diagnosis, treatment, immunization, or research of human beings or animals. Infectious medical waste includes: blood-saturated material; pathological waste including tissues, organs, body parts, and body fluids which may be the result of surgery or autopsies; human blood and blood products; cultures and stocks of a variety of infectious agents coming from various tests or used for research purposes; sharps; waste from different types of isolation units especially where there is a potential for spread of communicable disease; and contaminated animal carcasses, body parts, and bedding from research work.

Medical waste may also be produced during the manufacturing or use of various biological compounds including pharmaceuticals. Pharmaceutical waste includes prescription drugs or over- the-counter human or veterinary drugs which are partially used or expired.

Medical waste may be generated at home in the treatment of patients or the use of sharps. It may be found at the scene of traumas and become a hazard for cleanup. Medical waste may be solid, liquid, or sharps. The waste may also contain traces of chemotherapy agents which may be found on gloves, disposable gowns, towels, and intravenous setups. Medical waste must be separated from the normal waste streams of an institution during collection, containment, labeling, handling, storage, transport, treatment, and disposal.

Solid biohazardous waste includes any solid that will not puncture the skin. This material could be plastic, pipettes, syringes without needles, petri dishes, flasks with cultures in them, animal bedding which may contain hazardous substances, gloves, personal protective equipment, etc.

Sharps are responsible for 385,000 reported injuries each year with an unknown additional number of unreported injuries. The major cause of injuries is the use of disposable syringes and suture needles. They account for 51% of the total injuries. Injuries are also caused by wing steel needles, scalpel blades, and other sharp objects. (See endnote 41.)

Chemotherapeutic agents kill or prevent reproduction of malignant cells. The containers, personal protective equipment, empty tubes, syringes, animal bedding, and treated animals as well as anything coming from treated humans are hazardous to other individuals and must be contained.

Depending on the type of infectious waste, treatment techniques might include incineration, which can also contribute to air pollution; sterilization in special steam sterilizers used for this purpose only; and chemical disinfection, thermal inactivation, and irradiation. In any case after treatment, well-selected representative samples should be taken and analyzed to determine if all infectious agents and spores have been killed.

Best Practices for Disposal of Medical Waste

• • Conduct a survey of the entire institution to determine the type and quantity of anticipated non-hazardous and hazardous medical waste to understand the need for an appropriate budget, people, and programs to safely dispose of this material.
• • Establish a medical waste plan which involves all phases including the generating, segregating, packaging, treatment, transporting, and disposal of both the non-hazardous and hazardous portions of this special waste.
• • Train all personnel in safe operational methods and Best Practices for all phases of the medical waste plan and update the training in the event of an emergency and on an annual basis.
• • Track all medical wastes from origin to disposal and keep complete records of all activities involved in its storage, transportation, treatment, and disposal.
• • Collect all liquid biohazardous wastes including culture media, supernatant fluids, and human fluids in a sealed container clearly marked with the word “BIOHAZARD” and the universal biohazard symbol. Store in the biosafety cabinet and use an appropriate chemical disinfectant to destroy all organisms and spores. If treated with bleach at proper levels and no organisms or spores can be found on testing, it can go down the sink drain.
• • If the liquid biohazardous waste is mixed with either chemicals or radioactive agents, first treat as a biohazardous waste as described above, then treat as either a chemical or radioactive waste, and then use disposal methods which are acceptable for that type of waste stream.
• • For non-sharp biohazardous solid waste, place in a red biohazard bag which is kept within a rigid, resistant container with a tight-fitting lid. The biohazard bags must be at least 1.5 ml thick.
• • Biohazardous solid waste may be put into a special autoclave and sterilized or chemically disinfected with household bleach and then removed with the solid waste stream. Testing should always be conducted periodically to determine if the processes being used are effective.
• • Restrict the use of sharps to areas and procedures where they must be used and provide disposable gloves, and an approved sharps disposal container as well as a first-aid kit.
• • Report immediately, verbally and in writing as a priority, all injuries from sharps and the exact circumstances as well as the potential contaminants that might have a health effect on the individual. Seek immediate medical attention if the contaminants may cause a longterm or short-term disease.
• • All employees using or exposed to sharps must receive appropriate vaccinations prior to starting work and follow-ups as needed.
• • All employees using or exposed to sharps must receive appropriate training in the use and disposal of these items.
• • Disposable sharps should be used whenever or wherever possible and placed immediately after use into a leak-proof, puncture-resistant sharps disposal container at the point of use and the container must show the universal biohazard symbol in red or orange.
• • When using sharps, be aware of other individuals within the vicinity of your work and do not injure them.
• • Have specially trained individuals remove sharps to the ultimate disposal areas.
• • When dealing with broken glass whether contaminated or not, never use the hands to pick up the glass but rather forceps, tongs, scoops, or other mechanical means. Contaminated glass must be discarded into a special sharps container. Uncontaminated glass may be put in cardboard glass containers but make sure that sharp edges do not protrude through the container.

• • Use incineration as the method of choice for final disposal of sharps.
• • Remove all human remains including cadavers, body parts, or recognizable tissues or organs to the proper department for cremation or burial. Small pieces of solid unrecognizable tissue can go with the pathological waste to the incinerator.
• • Double bag all animals and animal tissues from research laboratories in red biohazard bags at the site of generation, transport to biohazard freezers, and dispose of as pathological waste which will be incinerated.
• • For the body parts from an individual with certain religious beliefs, the body parts must be buried according to religious law.
• • Place all chemotherapeutic waste materials in biohazard bags inside of a solid container with a tight-fitting lid and add a label showing that the waste has trace chemotherapy materials. Use yellow color coding on the outside container.
• • Conduct a study of the pharmaceuticals and partially used pharmaceuticals in an institution and determine how much of this becomes waste. Reduce the amount of unused pharmaceuticals with better inventory control and obtain where possible special medicines as needed instead of stocking them routinely. Segregate all pharmaceutical wastes from nonhazardous material and dispose of it through incineration at a hazardous waste incinerator or place it in a hazardous waste landfill after it has been treated.
• • All equipment used to work with infectious materials must be completely decontaminated before disposal. One of the best techniques is to use a 10% bleach solution which has been freshly made and has been in contact with the equipment for a minimum of 10 minutes.

Reduction of Non-hazardous Solid Waste Prior to Generation

General Best Practices for All Forms of Non-Hazardous Solid Waste