Handling Health Care Waste with Less Risk
Health care waste exposes hospital workers to greater risks than more typical waste-streams, and the staff who regularly handle, clean up, and dispose of these materials bear the brunt of the hazard. Contact with medical waste can lead to injury, exposure to toxic substances, and even infections of all kinds.
Unfortunately, we cannot change the constitution of health care waste itself. There will always be infectious refuse, biohazards, and disease-carrying sharps in the hospital waste stream. The way to protect cleaning workers in the health care field, then, is to prevent contact between the worker and the waste.
In order to understand the hazards associated with medical waste, and to create solutions that will keep hospital workers safe, we must start with a clear understanding of exactly what we mean by “medical waste.” What exactly lies inside the hospital hazmat bin?
Defining “Medical Waste” According to the EPA
The U.S. Environmental Protection Agency, which regulates safe disposal of health care waste, defines the substance as “a subset of wastes generated at health care facilities, such as hospitals, physicians’ offices, dental practices, blood banks, and veterinary hospitals/clinics, as well as medical research facilities and laboratories.”
In general, the EPA says, “medical waste is healthcare waste that may be contaminated by blood, body fluids, or other potentially infectious materials.” Regulators at the EPA typically call these materials “regulated medical waste,” and define them according to two particular criteria: These materials have either “the potential...to transmit infection” or they “possess a risk to public health or the environment for reasons other than infections potential.”
Now, a regulatory note: Since the 1988 Medical Waste Tracking Act expired in 1991, the states have taken over regulation for the handling and disposal of health care waste. That said, the EPA has produced Model Guidelines for State Medical Waste Management. These suggestions provide a decent baseline for understanding safe handling of health care waste across the nation.
Types of Medical Waste and the Risks They Carry for Waste-Handling Staff
The EPA identifies 10 discrete types of medical waste. Note that not all the contents of a hospital trash can are technically health care waste, and not all of these materials expose handlers to unique hazards.
Waste materials that do not contain infectious substances, sharp edges, radioactive or cytotoxic features, or similar risks are not considered “medical waste” from the perspective of a hospital waste-safety program. Keeping these less harmful types of waste separate from their more dangerous counterparts can help prevent injury among waste handling staff in health care settings.
The EPA’s categories of potentially harmful medical waste include:
- Used sharps. These include needles, scalpels, and broken glass that have been used in the care of humans or animals. Sharps are particularly dangerous when they’ve been exposed to infectious agents, as they carry the risk of transmitting blood-borne pathogens as well as a greater risk of internal introduction of common viruses, bacteria, and other agents of disease.
- Specimen cultures. Often generated in research projects or during diagnostic procedures, cultures and stocks of infectious agents can spread disease. This category of waste includes not just the cultures themselves, but also dishes, tools, and any other surfaces that come into contact with the pathogens in question.
- Blood. Human blood can carry pathogens, clearly. In this category of medical waste, the EPA calls special attention to bulk bagged blood as well as any concentration of blood components that may drip, pool, or run.
- Pathological wastes. These include body tissues removed during surgical procedures or, in the case of postmortem activity, that aren’t diverted to interment or cremation.
- Isolation wastes. As the name of this category implies, isolation wastes are materials that have been contaminated with biological substances (blood, secretions, etc.) that might carry a risk of infection. These wastes are isolated from non-medical wastes in order to prevent the communication of illness.
- Animal medical waste. Primarily from research and veterinary centers, animal tissues that carry infective agents are a risk-generating substance, and therefore regulated by state agencies.
- Unused sharps. While unused needles and blades don’t necessarily carry a risk of infection, they can injure handlers. The psychological damage of being pierced by medical waste compounds the suffering, even where there’s little or no risk of infection.
- Radioactive isotopes below the threshold of the Nuclear Regulatory Commission regulations. Physicians use radioactive substances in certain diagnostic procedures, treatments for cancer, and to sterilize equipment. Those radioisotopes don’t emit enough radiation to trigger Nuclear Regulatory Commission regulations, but they can still pose a threat to human safety in sufficient concentrations, and require regulated disposal.
- Chemotherapy drugs (antineoplastics). Lifesaving cancer treatments can create risks for pregnant women. With enough concentration, these antineoplastics are regulated under the Resource Conservation and Recovery Act, Subtitle C, which covers hazardous waste. But smaller trace elements are considered medical waste and regulated at the state level.
- Chemicals that meet the definition of hazardous waste according to the RCRA, but in traces that don’t meet the volumic threshold set forth in the RCRA Subtitle C. Certain chemical sterilization agents are risky enough to be considered hazardous waste by the EPA. These substances are subject to regulation as medical waste in the context of the health care industry waste handling system.
Of all the above categories, the EPA considers used sharps to carry the most risks to staff designated to handle health care waste. This is “because of their ability to puncture the skin, thereby creating a portal of entry for the transmission of disease.”
As with other types of medical waste, the best way to protect custodial workers in hospitals from these hazards is to limit exposure, preferably to the point where there is no contact at all between waste and worker.
Protecting Health Care Workers While Handling Medical Waste
Final disposal of medical wastes can take many forms. Some may be burned in a special incinerator, some is sterilized with steam or chlorine, while sharps may eventually be ground or shredded.
Regardless of the method of disposal, hospital custodial staff are typically responsible for moving isolated haz-mat bags of medical waste to a collection site or final disposal center (if such is located on the hospital premises). Here are a few tips for how hospital cleaning staff can reduce the risk of handling medical waste:
- While the particulars will vary from state to state, in the U.S., health care facilities must create and report on their waste-handling procedures. Comprehensive, ongoing training in a safety-conscious waste management plan is probably the most effective way to reduce the hazards of handling medical waste.
- Medical waste may require several types of collection bins and liners. Liners must be strong and free of damage; when collecting liquids, double bag. Bins must be clearly labeled to keep various types of medical waste separate. Sharps should be collected in rigid, puncture-resistant vials or boxes before disposal, and should not be crushed at any point in the disposal process.
- Material handling equipment used to transfer medical waste bins or liners should be made of smooth, nonporous materials. Stainless steel is ideal. Staff should disinfect material handling equipment between uses, and ensure that waste-handling carts and Bin Dumpers are only used for waste.
- When collecting the contents of bins through tipping or dumping, the outflow must be gentle and controlled to prevent the expulsion of contaminated air. Operators of Bin Dumpers should be protected by a PET-G Operator Guard, available through Solus Group.
- Labeling systems and training on those systems are vital to the success of a medical waste-management plan. Color-coding of bins and labels is a popular and effective method of maintaining separate waste streams — as long as managers invest in sufficient training. One recent study verifies that training on appropriate waste management procedures is highly effective. Participants in the study went from just 9.6 percent possessing a “high”level of knowledge on waste management procedures to 97.3 percent, following a training intervention.
Hospitals and other health care facilities exist to improve health, including the health of their employees. Careful planning and investment in material handling equipment can ensure that workers who manage medical waste do so safely and effectively, continuing to offer excellent care for patients and responsible stewardship of the waste that care generates.
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