6.1.4 Separation of Infectious and Noninfectious Wastes

Infectious and noninfectious wastes should be separated at the point of generation. If the infectious waste contains noninfectious hazards, it should be identified and subjected to additional treatment.

Infectious waste should be discarded into clearly identifiable containers or plastic bags that are leakproof and puncture-resistant. Red or orange bags are usually used for infectious waste. The containers should also be marked with the universal symbol for biological hazards (see Figure 6-1).

Figure 6-1. Universal symbol for biological hazards. The symbol is fluorescent orange or orange-red. The background may be any color that provides sufficient contrast for the symbol to be clearly defined.

6.1.5 Packaging

Infectious wastes should be contained from the point of origin to the point at which they are not longer infectious. The packaging should be appropriate for the type of waste involved, and it muse endure handling, storage, transportation, and treatment.

Liquid infectious wastes can be placed in capped or tightly stoppered bottles or flasks. Large quantities may be placed in containment tanks.

Solid or semisolid wastes may be placed in plastic bags, but the following recommendations should be heeded:

• Select tear-resistant bags. Plastic bags are judged by their thickness or durability as evaluated by the ASTM dart test (ASTM 1975). Use one or both of these criteria in the procurement process. The most important consideration is tear-resistance.

• Do not place sharps, sharp items, or items with sharp corners in the bags. (Place sharps in impervious rigid, puncture-resistant containers made of glass, metal, rigid plastic, or wood.)

• Do not load a bag beyond its weight or volume capacity.

• Keep bags from coming into contact with sharp external objects.

• Consider double bagging.

Some treatment techniques required special packaging characteristics. For example, incineration required combustible containers, and steam sterilization requires packaging materials such as low-density plastics that allow steam penetration and evacuation of air.

6.1.6 Handling and Transportation

When the waste is to be moved about for treatment or storage, special handling or packaging may be necessary to keep bags intact and to ensure containment of the waste. The following procedures area recommended:

• Single-bagged waste and containers of sharps and liquids should be placed within a rigid or semirigid container such as a bucket, box, or carton lined with plastic bags.

• Containers should be covered with lids during transportation and storage.

• When handling or transporting plastic bags of infectious waste, care should be taken to prevent tearing the bags. Instead of chutes or dumbwaiters, carts should be used for transporting bags of infectious waste within the facility.

• Carts and recyclable containers that are used repeatedly for transport and treatment of bagged waste should be disinfected after each use. Single-use containers should be destroyed as part of the treatment process.

• Infectious waste should not be compacted before treatment. This process could damage the packaging and disperse the contents, or it could interfere with the effectiveness of treatment.

• Outside the hospital, infectious waste should be transported in closed, leakproof dumpsters or trucks.

• The waste should be placed in rigid or semirigid, leakproof containers before being loaded onto trucks.

6.1.7 Storage

• Infectious waste should be stored for a minimum amount of time and should be packaged securely enough to ensure containment of the waste and to prevent penetration by rodents and vermin.

• Limited access to the storage area is recommended.

• The universal biological hazard symbol (Figure 6-1) should be posted on the storage area door, waste containers, freezers, or refrigerators.

• Containers for biohazardous material should be a distinctive red or orange color.

6.1.8 contingency Measures

Contingency measures should be developed to deal with emergencies that occur during the handling, transportation, or disposal of infectious waste. Emergencies include spills of liquid infectious waste, ruptures of plastic bags or other containers holding infectious waste, and equipment failures.

6.1.9 Ultimate Disposal

For ultimate disposal of treated infectious waste, EPA recommends contacting state and local governments to identify approved disposal options. EPA also recommends (1) The discharge of treated liquids and ground solids, e.g. pathological wastes or small animals, to the sewer system, and (2) Landfill disposal of treated solids and incinerator ash. Landfilling of infectious wastes is allowed in some states and prohibited in others. EPA recommends that only treated infectious wastes be buried in landfills. They further recommend that facilities secure the services of reputable waste handlers to ensure, to the extent possible, that ultimate disposal of hazardous wastes is performed according to applicable Federal, state and local regulations.

6.1.10 Training

All workers who handle infectious waste should receive infectious waste management training that includes (1) Explanation of the infectious waste management plan, and (2) Assignment of roles and responsibilities for implementation of the plan. Refresher courses should also be given periodically.

6.1 NONINFECTIOUS WASTES

6.2.1 Chemical Wastes

Chemical wastes include toxic chemicals, cytotoxic drugs, radioactive materials, and flammable and explosive wastes. These wastes should be classified at the time of collection to avoid mixing chemicals that are incompatible (NFPA 1983). Disposal of chemical wastes should be handled in accordance with good safety practices and applicable government regulations. Persons or agencies involved with the removal of these wastes should be informed of their characteristics and hazards.

6.2.2 Cytotoxic Wastes

OSHA has issued work practice guidelines for workers who deal with cytotoxic (antineoplastic) drugs (OSHA 1986). These guidelines are reproduced as Appendix 7 of this document. They address drug preparation, drug administration, waste disposal, spills, medical surveillance, storage and transport, training, and information dissemination.

6.2.3 Radioactive Wastes

Three classes of radioactive wastes may be found in hospitals: solids, liquids and gases. This section summarizes the recommendations of the National Council on Radiation Protection and Measurements (NCRP 1976).

Solid radioactive wastes may include rags or papers from cleanup operations, solid chemicals, contaminated equipment, experimental animal carcasses, and human or experimental animal fecal material. Human and animal fecal material may generally be disposed of through the sanitary sewer system (NCRP 1976). For other solid wastes, disposal depends on the half-life of the radionuclide. For those nuclides with short half-lives, the solid material may be stored in a secure place until decay has occurred. Solid waste contaminated by nuclides with long-half-lives should be disposed of by a licensed commercial disposal company. Contaminated equipment should be cleaned with large amounts of water, which should be disposed of as radioactive liquid waste.

Radioactive urine may generally be disposed of immediately through the sanitary sewer system, but the toilet should be flushed several times after each use (Stoner et al. 1982). In cases in which the patient has received a large dose of radioactive iodine, urine is generally collected for the first 48 hr after administration, taken to the laboratory for analysis, and flushed down the sanitary sewer system with large quantities of water. Other liquid wastes can be handled in the same manner as solid wastes. Those with short half-lives can be stored in a sealed container until the radioactivity decays; those with long half-lives should be disposed of by a licensed disposal company.

Gaseous radioactive wastes should be vented to the outside of the hospital so that recirculation of the exhaust air does not occur.

6.2.4 Flammable Wastes

Refer to Sections 3.1.3 and 3.1.4 for discussion of flammable and explosive wastes.