Medical waste includes all infectious waste, hazardous (including low-level radioactive wastes), and any other wastes that are generated from all types of health care institutions, including hospitals, clinics, doctor’s (including dental and veterinary) offices and medical laboratories.

What is Medical Waste

REGULATED MEDICAL WASTERegulated Medical Waste is a subset of all medical wastes and include seven distinct categories:

1. Cultures and stocks of infectious agents.2. Human pathological wastes (e.g. tissues, body parts)3. Human blood and blood products4. Sharps (e.g. hypodermic needles and syringes)5. Certain animal wastes6. Certain isolation wastes (e.g. wastes from patients with highly communicable diseases)7. Unused sharps.

WHAT IS AN INFECTIOUS WASTE?1. Presence of a pathogen of sufficient

virulence2. Dose3. Portal of entry 4. Resistance of hostThus, for a waste to be infectious, it must contain a pathogen with sufficient virulence and quantity so that exposure to the waste by a person or animal could result in an infectious disease.

WHAT IS AN INFECTIOUS WASTE?EPA categorizes infectious wastes into the following seven categories:1. Isolation wastes – wastes generated by hospitalized patients who are isolated to protect others from communicable diseases.2. Cultures and stocks of infectious agents and associated biologicals – this category includes: - Specimens from medical and biological laboratories - Cultures and stocks of infectious agents from clinical, research, and industrial laboratories3. Human blood and blood products – this includes waste blood, serum, plasma, and blood products.

WHAT IS AN INFECTIOUS WASTE?4. Pathological waste – tissues, organs, body parts, blood, and body fluids. 5. Contaminated sharps – contaminated hypodermic needles, syringes, scalpel blades, Pasteur pipettes, and broken glass.6. Contaminated animal carcasses, body parts, and animal bedding 7. Miscellaneous Contaminated Wastes – these include: - Wastes from surgery and autopsy - Miscellaneous laboratory wastes - Dialysis unit wastes - Contaminated equipment

INFECTIOUS WASTE MANAGEMENT PLANS

Components of an Infectious Waste Management Plan: 1. Designation of the waste that should be managed as infectious 2. Segregation of infectious waste from the noninfectious waste3. Packaging4. Storage5. Treatment6. Disposal7. Contingency measures for emergency situations 8. Staff training

DESIGNATION OF AN INFECTIOUS WASTE

The infectious waste plan for your facility should specify which wastes are to be managed as infectious wastes. A responsible official or committee should determine any other miscellaneous wastes should be handled as an infectious waste.

SEGREGATING MEDICAL WASTES Segregation of infectious wastes at the point of origin. Segregation of infectious waste with multiple hazards as necessary for management and treatment. Use of distinctive, clearly marked containers or plastic bags for infectious wastes. Use of the universal biological hazard symbol on infectious waste containers as appropriate.

SEGREGATING MEDICAL WASTES Whenever possible, do not combine medical waste with hazardous chemicals or radioactive waste. Separate sharps waste from other medical wastes. Sharps should be stored in puncture-proof containers. Separate pathology wastes from other medical wastes. Separate chemotherapy wastes from other medical wastes.

SEGREGATING MEDICAL WASTESIf different types of waste are mixed, treat mixtures as follows: Mixtures of medical and radioactive waste --decontaminate the biohazardous component and manage as radioactive waste. Mixtures of medical and hazardous chemical waste -- if safe to do so, decontaminate the biohazardous component and manage as chemical waste. Mixtures of medical, radioactive, and hazardous chemical waste -- if safe to do so, decontaminate the biohazardous component and manage as radioactive waste.

PACKAGING INFECTIOUS WASTE Selection of packaging materials for the type of waste handled:

- Plastic bags for solid or semisolid infectious waste.

- Bottles, flasks, or tanks for liquids. Maintains its integrity during storage and transport, Closing the top of each bag Place liquid wastes in capped/ tightly stopped bottles. Do not compact infectious wastes before treatment.

HANDLING SHARPS

The most common times of risk for spreading bloodborne pathogens occurs: –Recapping needles –Packing in puncture-resistant sharps

containers –Accidental breakage of the tubes used

for collection of blood

HANDLING SHARPSTo protect against needlestick injuries: Avoid the use of needles where safe and effective alternatives are available. Use devices with safety features that reduce the risk of needlestick injury. Avoid recapping needles. Safe handling and disposal of needles

PACKAGING OF SHARPSRigid puncture-resistant containers Must be red in color, have a biohazard label, are in the immediate area where sharps are used. Must remain upright throughout use and be replaced routinely. Containers of contaminated sharps will be closed immediately. Secondary containers, prevent leakage during handling, storage, transport.

STORAGEStorage temperature and duration are important considerations. Locating the storage area near the treatment site. Minimizing storage time. Proper packing and the exclusion of rodents and vermin. Limited access to storage areas. Prominently displaying the universal biological hazard symbol on storage area door, waste containers, etc.

TRANSPORT Avoidance of mechanical loading devices Frequent disinfection of carts Placement of all infectious waste into rigid or semi-rigid containers Transport of infectious waste in closed leakproof trucks or dumpsters. Use of appropriate hazard symbols

MEDICAL WASTE HAULING

Transporting by the U.S. Postal Service may be arranged

A mailed parcel of used sharps must be mailed as First Class or Priority Mail. No package may be more than 35 pounds, or 50 ml.

MEDICAL WASTE HAULING1. By a healthcare professional employed by the facility. 2. By contract with a transporter registered with the state.3. By mail, parcel post, or courier service (sharps only).

ON-SITE TREATMENT

1. Autoclaving (steam sterilization)2. Incineration3. Thermal inactivation4. Gas/Vapor Sterilization5. Chemical Disinfection6. Sterilization by irradiation (radiofrequency and microwave)

AUTOCLAVING Autoclaving (heating under high pressure)

Steam sterilization, within a pressure vessel at high temperatures accomplished primarily by steam penetration.

Low-density material such as plastics, metal pans, bottles, and flasks.

High-density polyethylene and polypropylene plastic should NOT because they do not facilitate steam penetration

AUTOCLAVING Plastic bags should be placed in a rigid container - spillage and drain clogging. Bags should be opened and caps and stoppers should be loosened Separate infectious wastes from other hazardous wastes. Infectious waste that contains noninfectious hazards should not be steam-sterilized. Waste that contains antineoplastic drugs, toxic chemicals, or chemicals that would be volatilized by steam should not be steam-sterilized.

AUTOCLAVING Persons involved in steam sterilizing should be trained in handling techniques to minimize exposure to hazards from these wastes. These should include: •Use of protective equipment •Minimization of aerosol formation •Prevention of spillage during autoclave loading/unloading •Prevention of burns from handling hot containers•Management of spills Check autoclave temperature to ensure that the proper temperature is being maintained for a long enough period during the cycle. Steam sterilizers should be routinely inspected.

INCINERATIONNewly Regulated Emissions from Medical Waste Incineration: 1. Particulate Matter2. Carbon Monoxide3. Dioxin4. Sulfur Dioxide5. Hydrogen Chloride6. Nitrogen Oxides7. Cadmium8. Lead9. Mercury

THERMAL INACTIVATION Thermal inactivation involves the treatment of waste with high temperatures to eliminate infectious agents. This method is usually used for large volumes. Liquid waste is collected in a vessel and heated by heat exchangers or a steam jacket surround the vessel. The types of pathogens in the waste determine the temperature and duration of treatment. After treatment, the contents can be discharged into the sanitary sewer in a manner that complies with State, Federal, and local requirements. This method requires higher temperatures and longer treatment cycles than steam treatment.

GAS/VAPOR STERILIZATION

Gas/vapor sterilization uses gaseous or vaporized chemicals as the sterilizing agents. Ethylene oxide is the most commonly used agent, but should be used with caution since it is a suspected human carcinogen. Because ethylene oxide may be adsorbed on the surface of treated materials, the potential exists for worker exposure when sterilized materials are handled.

CHEMICAL DISINFECTION Chemical disinfection is the preferred treatment for liquid infectious wastes. Consider the following: – Type of microorganism – Degree of contamination – Amount of proteinaceous material present – Type of disinfectant – Contact time – Other relevant factors such as temperature, pH, mixing

requirements, and the biology of the microorganism Ultimate disposal of chemically treated waste should be in accordance with State and local requirements.

STERILIZATION BY IRRADIATIONAdvantages of irradiation: Electricity requirements are nominal. Steam is not required. No heat or chemicals remain the treated waste.The principal disadvantages are as follows: Capital costs are high. Highly trained personnel are required. Space requirements are great. Worker exposure as a result of leaks in seals or poor work practices. Disposal of the radiation source may pose problems.

RADIOFREQUENCY IRRADIATION Large radiofrequency irradiation medical waste treatment units include an initial destruction phase. The waste is automatically fed into a waste grinding device where it is shredded and sprayed with steam to increase the moisture content of the waste to approximately 10 percent. The moist ground waste is then heated by exposure to radiofrequency irradiation. This process heats the waste to >90 C. The factors which affect radiofrequency irradiation treatment of medical waste include the frequency and wavelength of the irradiation, the duration of the exposure, destruction and moisture content of the waste material, temperature achieved throughout the waste load during treatment, and waste storage duration.

MICROWAVE IRRADIATION Large microwave irradiation medical waste treatment units include an initial destruction phase. The waste is automatically fed into a waste grinding device where it is shredded and sprayed with steam to increase the moisture content of the waste to approximately 10 percent. The moist ground waste is then heated by exposure to six microwave irradiation units over a 2 hour period. This process heats the waste to > 90 C. The factors which affect microwave treatment of medical waste include the frequency and wavelength of the irradiation, the duration of the exposure, destruction and moisture content of the waste material, process temperature, and the mixing of waste during treatment.

DRAIN DISPOSAL Some liquid medical wastes, such as human blood, may be disposed of in sinks if the waste is first autoclaved or brought to a final concentration of 1 percent bleach. The following medical wastes may not be drain disposed: •Human or animal cultures suspected of containing infectious agents •Cultures and stocks of infectious agents •Wastes from the production of infectious bacteria, viruses, spores, discarded live and attenuated vaccines Non-infectious medical waste disposal should only be made to sanitary sewers only.