medical waste nc
DESCRIPTION
Hospital WasteTRANSCRIPT
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Medical WasteMedical Waste
Bill Patrakis
Environmental BiologistNC Department of the Environment & Natural ResourcesDivision of Waste ManagementSolid Waste Section
919-508-8512
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Main points of this presentation.Main points of this presentation.
Medical waste is part of a larger solid waste problem.Medical waste is part of a larger solid waste problem.
Most waste generated in a healthcare facility can be classified Most waste generated in a healthcare facility can be classified as as medical waste.medical waste.
The state has a very narrow definition for what is considered tThe state has a very narrow definition for what is considered to be o be regulated medical waste.regulated medical waste.
Healthcare facilities often spend more than is necessary to treaHealthcare facilities often spend more than is necessary to treat t medical waste that is not defined as regulated. This increases tmedical waste that is not defined as regulated. This increases the he cost of healthcare and wastes resources.cost of healthcare and wastes resources.
Strategies exist to help minimize the amount of wastes and moneyStrategies exist to help minimize the amount of wastes and moneythat healthcare facilities spend on medical waste treatment.that healthcare facilities spend on medical waste treatment.
Know where to get more info, if you need it.Know where to get more info, if you need it.
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Tons of Solid Waste Disposed of by North Carolina
0
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
12,000,000
1990
-9119
91-92
1991
-9219
92-93
1993
-9419
94-95
1995
-9619
96-97
1996
-9719
97-98
1998
-9919
99-00
1999
-0020
00-01
2001
-0220
02-03
2003
-0420
04-05
2005
-06
Fiscal Year
T
o
n
s
-
0200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000T
o
n
s
Fiscal Year
Actual Imports / Exports
Imports 87,393 74,185 41,840 21,614 117,981 144,116 108,803 119,202 137,307Exports 629,415 1,166,875 1,106,897 900,743 882,247 971,286 1,048,111 1,161,926 1,234,307
FY 1997-1998
FY 1998-1999
FY1999-2000
FY 2000-2001
FY 2001- 2002
FY 2002-2003
FY 2003-2004
FY 2004-2005
FY 2005-2006
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O North Carolina is a net exporter of solid waste. Much of it going to Virginia and South Carolina.
O In 1997, the Supreme Court determined that garbage was a commodity that could be traded across state lines.
O Landfills are becomely increasingly difficult to site and expensive to construct.
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O Landfill operators have the right to reject any waste for disposal in their landfill, even if state regulations allow landfill disposal of such wastes.O Modern day landfills are not dumps. O Highly regulated and highly engineered, ongoing construction projects for the life of the landfill.
O No scavenging is ever allowed.O All wastes are required to be covered with soil at end of the work day.
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Medical WasteMedical Waste
Medical waste means any solid waste which is generated in the diagnosis, treatment, or immunization of human beings or animals.
(does not mention care and feeding)
General Statutes 130A-309.2615A NCAC 13B .1200
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BiohazardousBiohazardous waste generated outside waste generated outside this definition is not considered to be this definition is not considered to be medical waste.medical waste.
for example for example -- trauma scenes trauma scenes
the exception is animals that died from a the exception is animals that died from a zoonoticzoonotic disease disease (e.g.(e.g.--rabies, BSE)rabies, BSE) ..
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Regulated Medical WasteRegulated Medical WasteO Regulated medical waste means blood
and body fluids in individual containers in volumes greater than 20 ml (about the size of a test tube), microbiological waste, and pathological waste .
O Roughly 9 percent to 15 percent of the waste stream at hospitals is regulated medical waste.
O Regulated medical waste must be treated prior to disposal.
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Blood and Body FluidsBlood and Body FluidsO Blood and body fluids means liquid
blood, serum, plasma, other blood products, emulsified human tissue, spinal fluids and pleural and peritoneal fluids.
O Dialysates, urine, and feces are notblood or body fluids under this definition.
O Preferred method of treatment- dispose of in a commode.
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Microbiological WasteMicrobiological WasteO Microbiological waste means cultures
and stocks of infectious agents, including, but not limited to, specimens from medical, pathological, pharmaceutical, research, commercial and industrial laboratories.
O Can be autoclaved, incinerated, or treated with disinfectant chemicals (bleach 1:5).
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Pathological WastePathological WasteO Pathological waste means human
tissues, organs and body parts; and the carcasses of animals that were knownto have been exposed to pathogens or that died of a known or suspected disease transmissible to humans.
O Only method of treatment- incineration(and other approved methods).
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Disposal of SharpsDisposal of SharpsO The rules do not require treatment of
sharps before disposal. O They must be packaged in a container
that is rigid, leak-proof when in an upright position and puncture resistant.
O The package then may be disposed of with general solid waste.
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INSTITUTIONALLY GENERATED MEDICAL WASTEREGULATED MEDICAL WASTE NON-REGULATED MEDICAL WASTESharps
PATHOLOGICALWASTES &
CARCASSES OFINFECTEDANIMALS
CULTURES &BROTHS OF
KNOWNPATHOGENS
BLOOD &BLOOD
PRODUCTS,PLEURAL,SPINAL,
PERITONEALFLUIDS
PROPERLYTAGGED
ANDPACKAGEDIN A RIGID,PUNCTURE
PROOFCONTAINER
URINE,FECES,
DIALYSATES
PUBLIC WASTEWATER
TREATMENTPLANT
DRESSINGS, GOWNS,BANDAGES GLOVES,
TUBING, PAPER,PLASTIC, AND
EVERYTHING ELSE
OV
ER
90
% O
F ME
DIC
AL
WA
ST
E S
TR
EA
MAUTOCLAVED,MICROWAVEDCHEMICALS,OR OTHERAPPROVEDMETHOD.
INCINERA-TION
>>>>>MUNICIPAL SOLID WASTE STREAM>>>>>>>>>>>
For More Info: www.wastenotnc.org/programs/medical
NC DENR MEDICAL WASTE MANAGEMENT
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Not Defined as RMW in NCNot Defined as RMW in NCO Medical waste such as dressings and
bandages (even when blood soaked), sponges,disposable instruments, used gloves, and tubing.
O These items are not included in the definition of regulated medical waste and may be disposed of without treatment in the general solid waste stream.
O Many generators choose to ship and incinerate non-regulated medical waste such as gloves, bloody bandages, dressings, and tubing.
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O Household waste (home injectors) is not included in the definition of medical waste and is not subject to the medical waste management rules.
O Household garbage has on average 100 times more pathogenic microorganisms than general medical waste.
O Generators are responsible for ensuring that waste is disposed of properly.
O There is a "50 Pound per Month" record-keeping exemption for small generators.
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O Some facilities, such as long-term care facilities, generate medical waste but little or no regulated medical waste.
O Hospitals are only 3% of generators, but account for 70% of medical waste.
O Alternative medical waste treatment technologies are listed on the website: wastenotnc.org/programs/medical
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OSHAO OSHA specifies certain features of the
regulated waste containers, includingappropriate tagging. This is meant to protect waste industry workers.
O OSHA definition of regulated waste is not intended to designate waste that must be incinerated or otherwise treated before landfilling. Does not address disposal.
O OSHA - definition of regulated waste may include waste such as bloody gauze, blood saturated dressings, used gloves, or tubing.
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O US EPA does not regulate medical waste in North Carolina.
O North Carolina does not require that sharps be incinerated.
O North Carolina does not prohibit landfilling of items that contacted blood and body fluids (trauma scenes).
O Transport of regulated medical waste must comply with US Dept. of Transportation and NC Waste Management rules.
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O North Carolina does not require cradle to grave tracking of medical waste.
This means we do not know who the generators and transporters are. Contact a regulated waste treatment provider to find a transporter.
O Waste Management regulates (permits and inspects) commercial medical waste treatment providers.
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Reduce and Reuse...Reduce and Reuse...O Eliminate unused items from custom
surgical packs (once pack is opened, unused items are discarded).
O Identify items that are not used regularly enough to justify inclusion in various packs.
O Tell manufacturer when one outdate item causes entire pack to be outdated (e.g. tetracaine in spinal tray).
O Estimated cost savings $30,000/yrO Est. waste prevention: 11,000 lbs/yr
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O Purchase washable surgical and isolation gowns, and sterilization trays.
O Convert surgical drapes into biopsy cloths.
O Consider switching to reusable medical instruments (e.g. stainless steel trays and laparoscopic instruments).
O Sanitize and reuse plastic fracture pans.O Sanitize and reuse graduated
measuring containers.O Estimated cost savings: $60,000/yrO Est. waste prevention: 50,000 lbs/yr
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O Determine if cloth towels can be reused and later sold as rags.
O Use cloth diapers.O Use worn diapers as cleaning rags.O Contract with haulers of RMW to
provide reusable containers for red bag wastes and sharps.
O Estimated cost savings: $200,000/yrO Est. waste prevention: 230,000 lbs/yr
Source: Ca. Waste Prevention Exchange
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RECYCLERECYCLEO Organizations exist that recycle unused
medical supplies- ace bandages to sutures.
O Accept used but working medical equipment - autoclaves to wheelchairs.
O REMEDY - find a link at our website.O HERO - Healthcare Equipment and
Recycling Organization at greennature.com
O Supplies and equipment donated to national and international charities.
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Benefits of RecyclingBenefits of Recycling
O Unused medical supplies are diverted to needy charities around the world. REMEDY attorneys can help resolve liability issues.
O Hospitals save money on waste that does not need to be treated and taken to the landfill.
O Valuable landfill space is preserved.
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Incinerators are regulated by three DENR divisions:1) Division of Waste ManagementSolid waste - due to ash. Ash is tested and if found to be high in hazardous materials then it is disposed of at hazardous waste landfill.2) Division of Water QualityWater Quality - due to water that is used to quench ash. It is taken to waste water treatment plant.3) Division of Air QualityAir Quality - due to effluent from the smokestack.
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O The cost of treating medical waste that does not require treatment adds to the cost of healthcare.
O 1.75 cents/lb. vs 55 cents/lb.
OWaste reduction strategies preserve valuable landfill space and save money.
Bottom Line...
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Where to get more Where to get more information?information?
Division of Waste Management website: wastenotnc.org/programs/medical
NC Division of Pollution Prevention p2pays.orgThank You!