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Medical Waste Management

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Medical Waste Management

Managing medical waste is a priority for every facility or business that generates this type of waste for the protection of people, animals, the community and the environment. Often referred to as HCW (Healthcare Waste), there are strict requirements in all aspects of these types of waste. While each state has their own individual management guidelines and laws, businesses must also comply with corresponding federal organizations such as OSHA (Occupational Safety and Health Administration) and DOT (Department of Transportation).

Medical waste is defined as any waste that is generated by a healthcare facility that may be contaminated with blood, body fluids or other potentially infectious materials. Most medical waste is sourced at hospitals, physician’s offices, blood banks, dental practices, research facilities, laboratories, and veterinary clinics/hospitals. Medical waste also includes any activities that are preventative, curative, and palliative in treatment in the field of both human and veterinary medicine. However there are other businesses and locations that have medical waste including but not limited to: coroner’s offices, funeral homes, tattoo parlors and body piercing businesses.

Often referred to as HCW (Healthcare Waste), there are strict requirements in all aspects of these types of waste.

Strict laws and guidelines have been established for the handling, containment, labeling, storage, transport, and destruction of medical waste based on the type of waste and the state requirements.

Classifications of Medical Waste

There are both potentially infectious and non-infectious types of medical waste. A majority of the non-infectious is typically disposed of via standard waste management. There are classifications to define each type including:

Non-risk HCW includes all waste that has not been infected or has any potential infection. Non-risk HCW makes up 75%-90% of the total medical institution waste generated. The balance of HCW that is considered infectious or potentially infectious has specific requirements from cradle-to-grave until it is rendered harmless.

HCW Risks: Occupational, Public Safety, Environmental

Exposure to infectious or potentially infectious HCW encompasses a variety of topics. Every individual that is involved in generating, packaging, storing, transporting, and treatment has the ability to be exposed to life-threatening diseases. Staff at medical facilities as well as patients and the general public are at risk whenever there is HCW present.

The high level requirements for treatment and disposal of HCW assist in maintaining the safety of the environment as well as any individuals that may be scavengers within landfills. In some areas, landfills are eventually transitioning into public places such as parks and playgrounds and without treatment of HCW to a harmless condition, people’s lives might be at risk for infection. Additionally, any materials that either leak or break down enters onto the land and water system, carrying viruses and diseases such as HIV, hepatitis B & C. Contamination can then infiltrate into communities causing widespread infections and transmissions.

While a majority of HCW is transported, treated and disposed of by licensed, trained and professional medical waste management companies, the employees of these companies would also be at risk without strict compliance of the guidance and emergency procedures that have been established by local, state, and federal laws.

Supervisory Steps for HCW Management

All organizations that generate, transport or treat HCW are required by local and/or federal OSHA laws to establish training procedures for their staff and themselves during standard working hours. The training encompasses all aspects of safety, protection, precautions, storage, and labeling of HCW for the best possible standards. The licensed medical waste disposal companies that employ are required to have all staff, including drivers to attend specific OSHA training classes that assist them in the safe transport and treatment of HCW. Acceptance of training is part of the approval of hiring of staff and is overseen by supervisors.

Many states have additional requirements that management must oversee for HCQ training. These include guidelines for emergency situations in case of exposure to potentially infectious agents as well as all materials needed to comply with emergency treatment. These can be specific to medical staff and/or those that transport and treat HCW.

Steps for HCW Management: Cradle to Grave

Each organization that generates HCW is required by law to comply with policies that define the safety precautions needed from the moment of generation to the final disposal when the HCW has been rendered harmless. The streamlined steps that are monitored include: generation, segregation, labeling, on-site storage, collection and on-site transportation, off-site transportation (optional), on-site treatment and disposal, off-site treatment and disposal.

Generation of HCW should be examined at the point of use and disposed of in the approved of method. Each type of HCW is identified and actions taken to reduce the potential of exposure to infectious agents. All items that are identified as non-infectious and can be recycled such as paper, cardboard, plastic wrappers, etc. should not be included as HCW. For safety purposes, a majority of equipment that is reused has been greatly reduced so that most now use single-use items.

Segregation is one of the largest priorities to ensure the safety of people and the environment. While only around 10%-25% of all HCW is deemed hazardous, the treatment and ultimate safe disposal is critical at the point of generation. Segregating HCW reduces risks of infectious transmissions as well as allowing those that transport and treat HCW to do so in the approved of and appropriate methods. Color-coded containers for each type of HCW assists in keeping staff safe so that they acknowledge which HCW is placed in the correct bins. Training for staff will include specific procedures for placing sharps and liquids in puncture-proof, leak-resistant bags prior to being placed into the containers. Sharps containers should never be filled over ¾ full so that it allows for closure of the container without fear of being cut or the skin pierced.

Labeling is also important as each container and bag should have the universal biohazard label showing. Supervisors should regularly monitor and examine to ensure that all staff are well-trained and all rules of disposal are being complied with. Special treatment HCW makes up around 2%-5% and should be immediately separated from all other HCW. Other specially handled HCW that requires attention includes radioactive waste and pharmaceutical waste. Containers that hold sharps should also have a label identifying the danger and that the container holds sharps.

On-site storage requires that a separate and safe area has been set aside for the storage of the HCW containers. The area should not be accessible to unauthorized staff or the general public, should not be near food or food preparation areas, should be clean, have good ventilation, temperature control, and lighting. The storage area should never be over any areas where the general public traffic occurs and should be designed to prevent birds, rodents, or insects from entering. The storage area should also be lockable to ensure that only authorized individuals have access. Some states have specific rules regarding the duration of storage time based on the volume/quantity. Only containers that have been designed for stacking should be stacked using the weight approval requirements.

Collection and on-site transportation is typically done by a professional and licensed medical waste disposal company. The staff of the company is trained in the safest methods for collection and will use PPE (personal protection equipment) such as industrial gloves, overalls, aprons, and boots. It is always recommended to avoid accumulation of waste and comply with state and local guidelines for collection. Collection is required to follow specific routes through the healthcare facility using loaded carts. Carts should not be overloaded and should be easy to load/unload. There shouldn’t be any sharp edges on any containers that may cause damage to other containers.

Off-site transportation is accomplished by a licensed and professional medical waste disposal company. As a transporter, they are responsible for trained drivers/staff, the condition of the vehicles used to transport, guarantee that the vehicles will not have any sharp edges that could cause contamination and that they are easy to load/unload, disinfect, and are designed to keep spillage from occurring. The transporter is also responsible for supplying the generator with confirmation documentation stating the final treatment and transition of HCW to a harmless condition.

Treatment and medical waste disposal is based on classifying the HCW as one of the types of waste: waste sharps, infectious and cytotoxic wastes and organic wastes such as body fluids and blood, and human anatomical waste. There are a number of ways of treatment, based on the type of waste so that they are rendered harmless and can be disposed of in a landfill.

Guidelines for HCW Waste types

Non-risk HCW can be disposed of using standard waste disposal services.  However any waste that could transmit potentially infectious diseases, bacteria, or viruses require special handling and disposal.

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