Waste not, want not. You remember that old saying. Well, in the case of medical waste, the saying mutates to waste not poorly, if you want not to have issues in terms of waste disposal compliance. Disposing of medical waste is a challenge for any medical, dental, or veterinary practice or hospital. If you need help in regard to understanding waste classifications and regulations, and utilizing disposal and recycling techniques adequately, MedTrainer can help. Our compliance training programs are designed to cover all aspects of medical compliance including waste handling. Health care facilities produce a variety of waste. Many are regulated at the state and local level, others at the federal. Regulated medical waste for infectious materials are usually governed by state regulations, while the hazardous waste materials are regulated by the federal government. Just knowing the regulations and being able to respond to them successfully is difficult; finding the best ways to comply can be a “waste” of precious manpower. Knowing the regulations you must adhere to, and finding compliant disposal techniques are vitally important to the over all health of your practice as well as your staff and community.
So what about handling practices? First of all, infection risk is a major issue. Pathological waste, lab cultures, sharps – all quite dangerous in terms of the possibility of contracting an infection, and careful handling of disposal is key to prevent that possibility. Second, there is the classification of hazardous waste disposal. Toxic materials such as chemotherapy compounds much follow additional rules based on special regulation under the Resource Conservation and Recovery Act established by the Federal government, as well as following additional state rules in many locations. In short, wastes that are regulated as both medical and hazardous can be a true challenge, as many disposal service providers who handle medical waste cannot accept hazardous items – it can be difficult to find disposal that takes both types of waste. Most states require that all medical waste is treated before being disposed of in order to reduce risk to acceptable levels. States often have different requirements for waste types and disposal.
The main goal of any waste treatment and disposal system is to make waste noninfectious. Incineration was the first technique used to accomplish this, and while the public was kept safe from infection, generators released toxic substances into the atmosphere. EPA emission standards changed, and so did the necessity for closure of manyon-site medical waste incinerators at medical facilities. Few still operate. Now, many facilities ship waste to a centralized, monitored incineration location or use other options. Additional waste treatment options include the use of excessive heat or contact with chemical materials designed to render them sterilized. Techniques include the use of microwaves systems, steam autoclaves, or dry heat/hot air for heat treatment. For chemical agents, the usual methods are chlorine, ozone, alkali or a combination of these treatments. When infections materials are involved, the waste treatment must be sufficiently strong to penetrate every section of the waste. Sometimes the best way to do this, particularly when dealing with anatomical waste, is to shred or grind the materials to bring the interior to the surface. Of course there is additional cost and maintenance involved in this process, and the riks of releasing pathogens through grinding or shredding must be taken into account with careful handling on equipment which has been specially designed for the processing of medical waste. The biggest down side to incineration is air quality issues and efficient energy usage. Many large amounts of fuel must be utilized to destroy waste, much of it used to boil water from the waste so that the organic materials will burn.
This generates greenhouse gas, and is also quite costly. Thermal treatment on the other hand utilizes high water content to advantage. Water helps to transfer and distribute heat throughout the mass of waste. Performing this treatment in a pressure chamber raises the boiling point of water sufficiently to kill most organisms. Autoclaves are particularly effective at this. In a microwave system, this type of thermal treatment subjects the waste to high intensity radio waves, efficiently delivering energy where it’s needed to sterilize. However microwave processing can be less efficient if waste is too dry. With either autoclaves or microwaves there is no emission from disposal. On the downside, these systems are expensive. Dry heat systems are less costly, but do necessitate the use of higher temperatures and longer waste exposure time periods. As dry heat systems don’t involve combustion, unwanted reactions aren’t an issue. Air moving through the system however can carry pathogens, creating the potential for release of them. Each of these systems require a minimum time of contact to fully destroy pathogens and process waste in a shorter time period. One method that produces the temperature desired is a plasma arc, a technique of electric discharge that creates an intense heat without combustion.
Chemical treatment is another form of waste treatment. Convenient and cost effective, they do however consume chemicals and create chemical based reactions present in the waste that can cause its own set of problems. Chlorine is a common option, working by stripping electrons out of organic compounds and oxidizing them. Ozone and Alkaline agents are also used, and it is important to avoid exposure to ozone due to the possibility of lung damage, and to alkaline agents which can damage both skin and lungs. Risks must always be carefully weighed. So, once waste has been rendered safely noninfectious, it still must be disposed of. Most categories of waste can then be handled like any other solid waste. But hazardous waste cannot be – it must be disposed of in compliance with regulations. There are also several types of regulated medical waste that require specific treatments, for those associated with infection spread, such as pathological waste, lab cultures and sharps – such as needles and scalpel blades. In the latter case, sharps must be disposed of in special containers and processed or encapsulated. Individual states have detailed regulatory rules. Sharps have more regulatory rules than other medical waste categories. And what about hazardous waste materials? Many provisions and regulations apply here too, particularly in regard to the mixes of hazardous wastes, indicating that otherwise non-hazardous waste, if mixed with even a minute amount of hazardous waste, falls under restrictions applying to hazardous wastes.
These mixed wastes offer many challenges all their own, as most hazardous waste haulers cannot handle medical wastes, and is the rare medical waste disposal facility permitted to accept hazardous items. What’s a health care practice to do? Minimizing the amount of this type of waste whenever possible is a good start, using special containers to hold the waste, and adhering to both state and federal regulations regarding containment. Disposal and recycling techniques for medical waste depends upon type of waste, such as hazardous, or anatomical, state and federal rules and regulations, and the types of disposal techniques available to you. The place to start is with knowledge of classifications and regulations, followed by assessing the best disposal techniques in terms of safety, efficiency, and cost. Health comes first, and regulations focus on that, but there are intricate details of rules that may make compliance more difficult than it should be if staff is not adequately trained to recognize them. Train for health and compliance, for safety and security. That’s the bottom line regarding waste disposal and classification knowledge.