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Medical Waste Guidelines for Infection Control



August 12, 2021



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Medical Waste Guidelines for Infection Control

Medical Waste Guidelines for Infection Control. Most of the medical waste is generated in healthcare settings, however, there are other locations where medical waste is generated. These settings include but are not limited to such places as: funeral homes, coroner’s offices, veterinarians, pharmacies, blood banks, long term care facilities, nursing homes, hospice houses, tattoo parlors, and body piercing companies.

Each type of medical waste is placed in a specific category that has a variety of local, state, and federal laws for compliance for handling, storage, transportation, and processes to render it harmless for disposal. Guidelines can be both confusing and complex and vary from state to state.

One of the key factors in medical waste identification is the ability to label the waste as “infectious” versus “noninfectious.” Infectious waste is the most dangerous as it involves any item that contains or could contain an infectious agent that is transmittable to humans, animals and/or the environment. Noninfectious medical waste is any waste that doesn’t contain any agent that transmits and infectious agent.  

Controlling infection is based on the ability to comply with regulations in all phases of dealing with medical waste. This entails understanding that even the equipment and materials that are used in association with patient diagnosis and treatment can be considered as infectious medical waste. Any material that has come into contact with patients that are infected, including their body fluids, blood, and tissue, may contain microorganisms that are infected.

Identifying Infectious Medical Waste

While there isn’t a specifically detailed universal method to determine how infectious some medical waste might be, there are some criteria that include the inoculum size, how virulent the organism may be, and how susceptible the person that is exposed to the infectious waste.  Due to this condition, all infectious waste falls under protocols requiring strict adherence for all phases from generation to the point of rendering it harmless in medical disposal.

There are three questions that should be addressed in determining if medical waste is infectious and could contain potential organisms that could transmit diseases:

1. Is there blood, body fluids, or tissue with organisms that are pathogenic in the medical waste that could produce disease? 

Any item that has been used in conjunction with a patient infected with a transmittable disease should be allocated as infectious waste. Any item associated with a patient involving a contagion could contain small to large amounts of microorganisms that can be dangerous to others.

2. Are their pathogenic and viable microorganisms in the waste?

Environments such as research laboratories deal with various microorganisms as part of their procedures. They gain the organisms from cultures that are sources from stool, sputum, blood, and a variety of body fluids. All of the items related to the research should be treated as infectious and properly disposed of to render them harmless.

3. Could the waste offer an entry mechanism for pathogenic organisms into a host that is susceptible?

An example of this answer would be in sharps waste. Sharps are any item that is or could be potentially infected with a bloodborne pathogen and can cut the skin. Accidents with sharps are one of the most common causes for occupational infection for healthcare workers. When sharps pierce the skin they create an entry portal for potential infection transmission. Since the infection status of a patient is not always confirmed, all sharps are considered to be infectious medical waste.

Types and Categories of Medical Waste

Most states and the federal government recognize the four types of medical waste:

Most states also identify the six types of regulated medical wastes as:

  1. Pathological/anatomical waste: Any item, organ, tissue, body part, or body fluids removed during autopsy or surgery.
  2. Human blood and any blood products: This includes serum, waste blood, bulk blood, blood products, and plasma.
  3. Stocks and cultures of agents that are infectious (also referred to as microbiological waste): These are specimens from pathological and medical laboratories and can include but are not limited to devices and culture dishes used in the transfer, inoculation, and mix process as well as discarded vaccines, both live and attenuated.
  4. Contaminated sharps: Any item that can pierce the skin that has been or could potentially be contaminated with an infectious agent. These can include but are not limited to: hypodermic needles, scalpels, blades, syringes, broken glass or plastic, and Pasteur pipettes.
  5. Isolation waste: This is waste that is generated when patients have been placed in isolation to protect others from a disease that is communicable.
  6. Animal carcasses, bedding, and body parts that are contaminated: This waste is sourced from animals that are intentionally exposed to pathogens as in research labs, biological production, or in testing in vivo pharmaceutical processes.

Steps To Take to Avoid Infection

Each state may have definitions that differ in distinguishing infectious and non-infectious waste. It is always a good practice to know all of the laws and guidelines of the state in which the practice is held. Any facility that generals medical waste, both infectious and non-infectious should:

Transport of Medical Waste

All states require that medical wastes follow strict guidelines for containment and storage prior to collection and transport for treatment. Occupational Safety and Health Administration (OSHA) has established measures to protect staff involved in the medical waste generation and who will be in charge of managing the wastes from the moment of generation to final disposal.

Before transport:

Depending upon the waste type, a leak-resistant bag identified as “biohazard” is typically used for RMW (regulated medical waste) containment. The bag must be sturdy and have the ability to be discarded without contamination of the exterior of the bag. If/when there is a possibility of contamination, a second biohazard bag is required. All bags must be tightly secured to be made read for disposal.

For sharps, puncture-resistant FDA-cleared containers can be purchased at a variety of sources as well as provided by the better medical waste management disposal companies. These containers are specifically designed to house any item that could cut the skin and contain or potentially contain pathogens. They have smaller top openings so that only the sharps can be placed inside and must have the ability to be tightly sealed. The sharps containers need to be identified with the universal biohazard label and only be filled to the 2/3 mark while they await pickup by a licensed medical disposal company.

For facilities that are involved in research and/or treatment of some rare conditions or diseases such as Ebola virus or Lassa fever, additional precautions are required to prevent the aerosol production in the handling of items that are blood-contaminated.

Storage:

Any generator that must store infectious medical waste must have a storage area that is safely away from general traffic and that only allows authorized personnel. Storage guidelines should be part of the generator’s overall safety and health protocols and included in their waste management rules. The storage area must:

Transport:

A majority of generators make use of a licensed, trained and certified medical waste disposal company or transport and proper disposal of all types of medical waste. The generator will coordinate with the disposal company for a pickup schedule for the medical waste. At the time of pickup disposal company drivers will load the medical waste onto certified trucks and supply the generator with the appropriate documentation required. The medical waste disposal company must comply with local, state, and federal guidelines for the various disposal methods as well as the Department of Transportation (DOT) procedures for transporting the medical waste. They will also supply the generator with a certificate of destruction for any audit or legal purposes.

Treatment of Regulated Medical Waste

The purpose of decontaminating or treating RMW is to reduce or destroy the amount of microorganisms in or on the medical waste and to render it harmless. Some medical institutions have in-house treatment facilities and are required to comply with the same local, state, and federal guidelines as standard medical waste treatment locations.

The greatest threat of RMW involves microbiologic wastes such as untreated stocks, cultures and amplified populations of microbes. Those purposely grown for research are typically grown in high concentrations so that they can be studied and are therefore dangerous if not destroyed. The greatest threat for injuries existing in dealing with sharps which contain dangerous transmittable diseases.  

Treatment processes depend upon the category of RMW. A majority of states are no longer accepting incineration as a treatment process due to strict emission rules. Treatment processes involve autoclaving, a high temperature steam process, chemical disinfecting, shredding/grinding/disinfection methods, and technologies that are energy-based such as radio wave or microwave treatments.  When steam sterilization is used the waste must be exposed to 250 degrees F (121 degrees C) for up to ninety minutes in an autoclave. Different time periods may be necessary depending upon the size of the load. Once the steam sterilization has been completed the residue left over can be handled safely and then discarded with non-hazardous sold waste depending upon the local and state guidelines.

In the case of onsite incineration, which is typically used for pathologic, microbiologic, and anatomic waste, the incinerator must comply with all EPA emissions standards.


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