Control of Infections in Liquid Waste Management
By Pat Tydell, RN, MSN, MPH, and Jack Donaldson, RN, CNOR, CSPDM
Disposal of fluids should always occur in a non-patient area.
One of the most crucial issues facing hospitals and other medical facilities today is protecting against disease transmission. Healthcare workers are often exposed to hepatitis B virus (HBV), human immunodeficiency virus (HIV), and other dangerous bloodborne pathogens on a daily basis. Through the institution of safe work practices and engineering controls, healthcare workers' exposure can be significantly reduced.
OSHA guidelines are clearly in support of standard precautions to treat blood and other body fluids as if they were infectious for HBV, HIV, and other bloodborne pathogens. The collection and disposal of biohazardous liquid can pose a significant risk, bringing an untold occupational challenge to hospital staff. From pathologic body sites, the microbial content of suction load may be high and contain significant pathogens.1 Bacterial content of abscesses can include Clostridium, Bacteroides, and Straphylococcus. The respiratory tract can contain Streptococcus, Pseudomonas, Klebsiella, Serratia, and a variety of gram negative organisms. The female genito-urinary tract can contain polymicrobial flora similar to that of the intestinal tract plus Herpes virus.1 When healthcare workers come in contact with these biohazardous fluids, reducing their exposure by minimizing splashing, spraying, and splattering is critical.
One source of biohazardous fluids that healthcare workers come in contact with on a daily basis is from suction canisters. The use of reusable and disposable suction canisters in the healthcare community and medical industry is widespread. The use of surgical and medical suctioning occurs in several areas throughout the hospital. These areas include the emergency room, intensive care units, oral surgery and obstetric departments and, most frequently, in the surgical department. The use of suction canisters can include general patient care areas as well.
Standard precautions is an infection control system that assumes that every direct contact with blood and body fluids is a potentially infectious exposure. This system is based on the premise that not all patients with bloodborne infections have been diagnosed, and therefore, precautions must be applied.2
Handling of Suction Collection Canisters
|Some products can inactivate a variety of bacteria and fungi in suction canisters.|
There are additional basic principles that should be followed for safe handling of suction canisters to minimize the risk to healthcare workers. Disposable units should be discarded when full or when removed from a patient. Although many hospitals (approximately 80%) have switched to disposable suction collection units, glass and metal units are still used. Some institutions have converted partially and have both systems in use.1 As with the suction canister itself, so too should the connectors and associated tubing be disposable. Use of disposables reduces the handling of the contaminated equipment by healthcare workers.
Care needs to be taken when removing the collection canister from the patient care areas. Liquid contaminated waste needs to be carried out in a sealed impervious container. Neither should the container be transported unless sealed to prevent spillage or contamination of others en route to its final disposal site. Once the protectively enclosed collector unit has reached a disposal area, its contents should be disposed of according to policy. The disposal should occur in a non-patient care area to avoid the contaminated aerosols generated by the suctioning process. The personnel doing this should be gowned, gloved and masked to protect against aerosolized contaminants, spillage, and splattering.
If the canister is reusable, additional care needs to be taken in order to place the equipment back in service. Also, a clean unit should always be available for back-up.
An engineering control system that helps reduce exposure to body fluids is liquid medical waste solidification products. Liquid medical waste solidification products have been used in the healthcare and medical industry for over 12 years. Healthcare workers have benefited from the protection these products provide including the elimination of spilling, splashing and aerosolization. However, until recently, none of the solidification technologies demonstrated the level of efficacy required by most states in order to convert the infectious waste to a non-infectious state and ultimately be disposed of in the white bag waste stream.
Unfortunately, there were solidifiers that received approval in some state agencies based on limited efficacy studies for landfill disposal. However, they were later determined to be ineffective treatment technologies and ultimately lost their approvals.
The disposal of medical waste is regulated on an individual state basis. Accordingly, not all the states have the same efficacy requirements. It is important to note, however, if a technology is approved by a certain state as an Alternate Medical Waste Treatment Technology. It has to be registered with the United States Environmental Protection Agency before it can be marked and sold in that state.3
Conversely, just because a solidification product obtains an US EPA registration, it does not mean it automatically becomes a countrywide-approved Alternate Treatment Technology. The product must still demonstrate the efficacy required within the state it plans to sell in.
If this process sounds confusing--you're right. However, in order to assist manufacturers through this process several state agencies formed a committee called State and Territorial Association on Alternate Treatment Technologies (STATT)4. This committee developed a guidance document for evaluating Alternate Technologies that have been registered with the US EPA as a chemical treatment product. In addition, Underwriters Laboratories Inc. (UL) has initiated the development of a standard. UL, through the Accredited Organization Method of American National Standards Institute (ANSI) is seeking recognition of this standard as an American National Standard.
The scope of the standard is as follows. The standard is intended to determine whether individual equipment or systems provide for microbial inactivation and reduction of the risk of injury to persons and damage to property related to their use.
- These requirements cover the construction, performance and maintenance of technologies employed as an alternate to incineration for the disposal of medical waste.
- Alternative medical waste treatment technology--as covered by these requirements--consists of various methods of microbial inactivation through the individual or combined use of heat generated by assorted media, chemicals and irradiation. It includes pre-and post-processing systems required to be used with the treatment technology.
- These requirements do not cover incinerators or any other equipment covered in whole or as part of a separate, individual requirement. In addition, the requirements do not cover:
a. Hazardous waste identified or listed in 40 CFR Part 261.
b. Radioactive waste defined and regulated by the Nuclear Regulatory Commission.
c. Domestic sewage materials identified in 40 CFR 261.4(a)(1).
A product that contains features, characteristics, components, materials or systems new or different from those covered by the requirements in this standard, and that involves a risk of fire, electric shock, or injury to persons shall be evaluated using the appropriate additional component and end-product requirements to determine that the level of safety, as originally anticipated by the intent of this standard, is maintained.
A product whose features, characteristics, components, materials, or systems conflict with specific requirements or provisions of this standard. Where considered appropriate, revisions of requirements shall be proposed and adopted in conformance with the methods employed for development, revision and implementation of this standard.
OBF Technologies' mission was to develop a product that would demonstrate the required efficacy as set forth by STATT and meet the proposal standards for Underwriters Laboratories, while keeping in balance with the environment.
In 1997, OBF Technologies developed the first protocol for a Sanitation/ Solidification product to be approved by the US EPA and subsequently received official registration from the US EPA March 7, 1997. EPA registration number 59839-1.
A widely used cold sterilant--known for demonstrating the high-level of efficacy (sterilization) when challenged by the most virulent organism--is glutaraldehyde. After several years of research and development, the company converted liquid glutaraldehyde into a patented dry crystal. This process allows the liquid glutaraldehyde to become encapsulated within a prilled silica crystal and is only released when it comes into contact with the liquid waste inside the suction canister. This technology allows the end user to benefit from the high- level of efficacy demonstrated by the dry glutaraldehyde crystal while minimizing the risk commonly associated with liquid glutaraldehyde. By combining the dry glutaraldehyde crystal with a fast and encapsulating group of acrylic polymers, the company developed new technology called PremiCide.
PremiCide is a suction canister sanitation and solidification system that allows for transport, storage, and disposal of sanitized medical waste.
The efficacy demonstrated by PremiCide includes a 410 log reduction of the Bacillus subtilis spore and 610 log Mycobacterium Phlei in 100% whole blood serum. In addition, it inactivates non-sporulating gram positive bacteria, fungi, non-sporulating gram positive bacteria, and crystals.
It is manufactured in single-use (unidose) sizes to sanitize all suction canister volumes. A patented closed delivery system called PremiGuard brings added safety to the treatment, handling, and disposal of liquid laboratory, human and animal waste.
The closed delivery system allows the treatment of infectious liquids to occur within the sealed collection canister, eliminating unnecessary chemical spills and potentially hazardous aerosolization and splashing of the infectious collected waste fluids. The cap was designed to fit most suction canister lids and can be used with or without suction.
To ensure the safety associated with the use of this solidification and treatment product, the company conducted several environmental studies and personal safety studies concluding that when used according to directions of use, the product does not qualify as a hazardous waste and the occupational exposure level to the dry glutaraldehyde is below recognized exposure limits. In addition, a LD 50 Acute Dermal Toxicity Study demonstrated an undetectable level of toxicity according to the procedure listed in the TSCR guidelines, 40 CFR Part 798.
Pat Tydell, RN, MSN, MPH, is the Risk Manager at North Chicago Veterans Administration Medical Center (VAMC) in North Chicago, Ill.
Jack Donaldson is the Nurse Manager of Sterile Processing at Sutter Medical Center in Sacramento, Calif.
1 Neblett, Thomas R. Ph.D. "Characteristics of Medical and Surgical Suction Systems. The Microbiology and Nosocomial Hazards of Collection Vessels." Published monograph of research conducted at Biosan Laboratories, Inc. 10657 Galaxie Ave. Ferndale, Mich. 48220.
2 Goodman, Terri, RN, MA, Ph.D. "Control of Infections Related to Bloodborne Pathogens." Infection Control Today. June, 2000.
3 Ng, Rebecca, BS, REHS. "Medical Waste Disposal Training and Audits." Infection Control Today. November, 1999.
4 Underwriters Laboratories, Inc. "Standard for Safety for Alternative Technologies for the Disposal of Medical Waste- UL2334." www.UL.COM/epn/medwaste.htm.
5 OBF Industries, Inc. www.enviro-safe.com
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