Infectious waste have a danger of disease outbreak if not properly managed.
What is an infectious waste
According to WHO, Infectious waste are waste contaminated with blood and other bodily fluids (E.g. From discarded diagnostic samples),cultures and stocks of infectious agents from laboratory work (e.g. waste from autopsies and infected animals from laboratories), or waste from patients with infections (e.g. swabs, bandages and disposable medical devices).
NOTE: Infectious waste is anything contaminated with human and/or animal:
- Bodily fluids, e.g. saliva, mucous, or pus.
- Waste products (faeces, urine, and vomit).
- Skin or tissue.
Types of infectious waste
- Blood Waste: It also contains blood products such as those found in containers or even perhaps as a saturated solid waste. Blood products include plasma, serum, as well as additional blood components.
- Pathological waste: This is another type of infectious waste. Pathological waste defines tissues or body parts removed from a human or animal either accidentally, during a surgical procedure, or an autopsy, and that is intended for disposal.
- Sharps: This include needles, scalpels, blades, or any “sharp” item that is used to inoculate, provide drugs, or to draw blood that are used on or derived from an animal or human. A number of possible medical waste generators dealing with sharps infectious waste include mortuaries, blood banks, hospitals, laboratories, as well as research facilities. Sharps can also include pipettes, lancets, or other discarded glass or hard, plastic vials that contain an infectious agent. Be aware that other examples of an object (sharps) capable of penetrating or cutting the skin can also include razor blades, suture needles, trocars, butterflies, broken capillary tubes, culture slides and dishes, as well as empty ampoules.
- Laboratory waste: Which can include cultures or stocks or agents that are created or used by laboratories in the development of treatments or analysis of disease processes that can be infectious to humans upon exposure. Such items can include wastes that come from the production of biological agents that may be potentially hazardous to humans. It also includes discarded live or attenuated vaccines that may prove infectious to humans.
- Regulated human body fluids: Regulated human body fluids can include but is not limited to amniotic fluid, cerebrospinal fluid, pleural fluid, pericardial fluid, and so forth. It’s also defined as anything that is stored in a container or a substance that may drip from solid waste items such as bedding or bandages that are soaked with body fluids.
- Animal waste from research: Scientific and medical research involving animals is a common source of infectious waste. As with humans, any blood, body part, or carcass of an animal that has been exposed to hazardous or infectious agents may also potentially cause harm to humans.
- Teeth: In some states, teeth are classified as an infectious waste. The CDC states that attracted teeth are subject to guidelines of the Occupational Safety and Health Administration’s Blood-borne Pathogen Standard, which deems extracted teeth to possibly contain infectious materials. Therefore, they should be disposed of in adequate and appropriate medical waste containers (with the exception of teeth containing amalgam, which are not to be incinerated). Refer to local and state regulations for disposal of teeth containing amalgam.
- Solid wastes: Some solid waste may also be deemed a source of infectious or biohazardous waste and include items such as IV equipment tubing, suction canisters, surgical gloves, personal protective equipment (PPE), as well as wound dressings, which may contain blood or bodily fluids that are “pourable, drinkable, squeezable, or flakable”, according to OSHA.
- Chemotherapy waste: This is also has the potential to be infectious, depending on the status of the patient and in the delivery of chemotherapy drug processes that have the potential to transfer blood or body fluids from one person to another. Common items that may be deemed infection may include tubing, sheets, pads, vials, gloves, containers, IV bags, and so forth.
- Any material contaminated with a communicable disease: Healthcare workers employed in a variety of healthcare scenarios including hospitals, nursing homes, outpatient clinics, and even veterinary facilities and tattoo parlors should always use protection to avoid exposure to communicable diseases or agents. In some nursing homes, influenza, urinary tract infections, and scabies may spread from one resident to another as well as to caregivers if proper identification, treatment, and use of personal protective equipment is not utilized.
Environmental Best Practice for Managing Infectious Wastes
Here are several tips on how you can minimize the environmental footprint of your infectious waste stream:
Understand the difference between infectious wastes and non-infectious wastes
It is not uncommon for there to be confusion about what is and isn’t considered infectious waste. This often leads to extra waste being treated as infectious. Body fluids that are exempt from the regulated waste rules include mucus, saliva, vomit, urine, and feces. Teeth are also not considered to be infectious waste (as long as they are not dripping with blood). Finally, the MPCA makes a clear distinction that blood-stained items that “will not release blood or body fluids when compressed” are not considered infectious waste. Therefore, items such as gowns, exam gloves, minor dressings, adhesive bandages, bedding, and sheets that may have blood staining on them, but would not release blood when compressed, should not be treated in your infectious waste stream. Over treatment of waste is expensive and taxing on the environment: trucks come more frequently to your facility, you use more bags and containers, and the disposal company exerts copious amounts of energy and water treating the waste you’ve sent them. If it doesn’t need to be in a red bag, it shouldn’t be in a red bag! Furthermore, you may find opportunities to recycle some of the wastes currently in your red bag that don’t need to be, such as sterilization blue wrap.
Reduce the number of “red bag” containers in your facility
It is common for facilities to want to put red bag containers in several areas. After all, in healthcare, don’t they belong everywhere? The answer to this is generally no. Regular patient rooms, exam rooms, nursing stations, and the like typically do not need access to a red bag waste stream. Focus your efforts on places likely to generate this waste, such as operating rooms, procedure rooms, and clinical laboratories. Items such as exam gloves, minor dressings, and adhesive bandages are not usually considered to be infectious waste, and there is no reason, as we saw in Recommendation #1, to over-treat your waste.
Reduce the size of the bags (and containers) you use
Filling containers until full is less wasteful than tying off very large red bags that are only partway full. If you aren’t producing enough waste in one area to fill a bag each day, consider switching to a smaller container with a smaller bag to save money on bags and reduce plastic waste. If you are using a 55-gallon bag in a small procedure room, you could probably downsize. Furthermore, smaller bags have the advantage of being removed more frequently, reducing odor issues. Remember to leave room to tie off your red bags according to your disposal company’s requirements.
Make your pickups count
If your infectious waste disposal company is coming to your site more than once per week, this is likely too often. You can save costs and reduce your carbon footprint associated with trucking by reducing your pickup frequency. Oftentimes, with proper storage practices, one pickup per week or less is sufficient for facilities large and small. Discuss your pickup schedule with your infectious waste disposal company.
Keep all “other” trash out of the infectious waste stream
It is far too common for facilities to use red bag containers as the regular trash, especially in places like operating rooms and procedure rooms. It is not uncommon to find wrappers, paper towels, exam gloves, and even pop cans in an infectious waste bin! Make sure your staff understands what the infectious waste stream is to be used for, and ensure they are not using it as an open trash can. This is not only environmentally preferable, but will also reduce your costs.
Consider using a reusable container for sharps
There are a few companies in Minnesota who provide reusable containers for collecting sharps. These containers are removed as-is once full and transported to the infectious waste disposal company. The containers are then emptied, sterilized, and returned to the stock of “usable” sharps containers. Reusable containers for sharps are preferable to disposable because there is much less plastic waste involved; the reusable containers can sometimes be washed hundreds of times or more before they are unfit for recirculation. Ask your infectious waste disposal company if they offer this service. If they do not, ask others in your healthcare network which companies they are using for reusable containers.
Eliminate your disposable suction canister system
Suction canisters are used in operating room settings, such as in hospitals, surgery centers, and other places where large-quantity suction of blood and body fluids may be necessary. Implementing a system that uses reusable canisters, or, better yet, is plumbed directly to the sanitary sewer, can help reduce the amount of infectious waste your facility generates. MnTAP performed an several years ago on the benefits of eliminating a disposable suction canister system.
Explore opportunities to do on-site treatment of infectious waste
Several companies now sell technology that allows you to process and treat infectious red bag waste at your site and then divert those wastes to your regular waste hauler. This is a relatively new idea to the healthcare industry, but some sites, particularly hospitals, are finding success with it. An article in Health Facilities Management magazine, Treating Regulated Waste, may help clarify the process and help you decide if it is something worth exploring at your facility.
Treating Infectious Waste
There are numerous non-incineration technologies sold to treat infectious waste. They can be classified as thermal, chemical, biological or irradiative technologies.
The most common is autoclaving. This uses high pressure steam, usually at 121-134oC, to disinfect waste so that it can be either recycled of disposed of safely.
Autoclaving is a highly flexible technology and one that many hospitals are familiar with as it is used for sterilising surgical instruments and many other sterile products.
Autoclaves are easy to operate, maintain and monitor. The majority of autoclaves operate on electrical power, but they can also use other fuels, predominantly gas.
Models available range from desktop units that process a few litres of waste, to machines for central treatment facilities, which are capable of processing tonnes at a time.
In addition to autoclaves, other waste treatment technologies use steam or dry heat as a disinfection agent. This includes microwaves, electrothermal disinfection, frictional heating and dry heaters. All of these operate below 180 degree celcius and do not change the physical or chemical form of the waste. As a result they produce little or no pollution, though care must be taken to ensure that wastes containing volatile chemicals such as solvents and mercury are not treated this way as they will be emitted to the atmosphere.
Chemical disinfectants are used by a number of technology providers. However, the majority of these involve persistent pollutants that will be emitted with the treated waste. An exception to this is ozone treatment, as this rapidly breaks down to oxygen. See the resources section for more information about these and other technologies.
Irradiative techniques that have been tested for infectious waste treatment include electron beams and ultraviolet light (UV-C). However, these are not in commercial use at present. Biological methods are not commercially available either, but biological breakdown in placenta pits and biodigesters can be used for pathological wastes and vermiculture (worm composting) has been tested for soft waste such as used bandages.
Whichever technology is chosen, proper monitoring is essential. Economical and simple tests called self-contained biological indicators, and costing around $2-3 each, can be used to check that the autoclave is operating effectively. UNDP has drafted recommended procedures for regular testing. Other types of test such as colour-changing paper strips can be used in certain circumstances but should not be used as a substitute for biological indicators.
Autoclaves for disinfecting medical waste should also undergo a validation when they are first installed. This will set appropriate operating parameters and should always be carried out, as all waste streams vary, and may also be packed differently. Lower cost autoclaves may be depend on gravity to fill with steam; these benefit from a technique called “pressure pulsing” which helps get steam deep into the waste. See the resources section for more information on this.
Infectious Waste Disposal
All laboratories or areas utilizing blood, blood products, body fluids and/or etiologic agents must have proper disposal containers.
Burn Boxes (cardboard disposal boxes) labeled for BIOHAZARD WASTE are to be used for disposing of all glass items that have come in contact with or contain blood/blood products or etiologic agents (test tubes, slides, pipettes, blood collection tubes, etc.). Unbroken contaminated glass must be discarded in this box. These biohazard boxes are to be used only once. Prior to transportation, each burn box must be placed inside an orange autoclave bag having the biohazard symbol with a properly completed Laboratory Waste label affixed to the bag. The opening of the bag must be closed and sealed with a rubber band or wire tie.
All needles, lancets and syringes are to be discarded into red plastic puncture proof containers labeled for SHARPS. All broken contaminated glass must also be discarded in this container.
A sharp is considered to be, but is not limited to, the following items: needles, scalpels, razor blades, microhematocrit tubes (used or unused) and all broken contaminated and broken uncontaminated glass or any other material which may puncture the skin. Broken uncontaminated glass or any other uncontaminated item which may puncture the skin should be disposed of in a puncture proof container as to not cause injury to the person handling the container.
Liquid cultures are to be disposed of by placing test tubes containing the cultures into test tub racks and placing the racks onto a stainless steel tray. If flasks are used to store cultures, they too can be placed on the tray.
Place all contaminated gloves, swabs, plate cultures of etiologic agents and absorbent paper products used to clean up spills in disposal bins that are lined with two (double bagged) biohazard bags.