Disposing of liquid and solid medical waste from the operating suite is a task that every healthcare facility must perform with an eye toward efficiency and cost effectiveness while protecting healthcare workers (HCWs) from exposure to pathogenic bacteria and viruses. HCWs 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, HCWs’ exposure can be significantly reduced.
The Occupational Safety and Health Administration (OSHA) defines regulated medical waste (RMW) as “liquid or semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials.”
On the federal level, the storage and management of medical waste is primarily regulated by OSHA, while on the state level there may be additional definitions and requirements for RMW. OSHA dictates the following:
• Contaminated reusable sharps must be placed in containers that are puncture-resistant, labeled or color coded, and leakproof on the sides and bottom
• Reusable sharps that are contaminated with blood or other potentially infectious materials (OPIM) must not be stored or processed in a manner that requires employees to reach by hand into the containers
• Specimens of blood or OPIM are required to be placed in a container that is labeled and color coded and closed prior to being stored, transported or shipped
• Contaminated sharps must be placed in containers that are closeable, puncture resistant, leakproof on sides and bottoms, and labeled or color coded
• Regulated wastes (liquid or semi-liquid blood or other potentially infectious materials, contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling, contaminated sharps, and pathological and microbiological wastes containing blood or other potentially infectious materials) must be placed in containers that are closeable, constructed to contain all contents and prevent leakage of fluids, labeled or color coded, closed prior to removal
• All bins, pails, cans and similar receptacles intended for reuse that have the likelihood of becoming contaminated with blood or OPIM are required to be inspected and decontaminated on a regularly scheduled basis
• Labels affixed to containers of regulated wastes, refrigerators and freezers containing blood or other potentially infectious materials, and other containers used to store, transport or ship blood or OPIM must include the biohazard symbol, be fluorescent orange or orange-red or predominantly so, with lettering and symbols in contrasting color; and be affixed as closely as possible to the container by adhesive or wire to prevent loss or removal
The Centers for Disease Control and Prevention’s Guidelines for Environmental Infection Control in Health-Care Facilities note that precisely defining medical waste on the basis of quantity and type of potential disease-causing agents present is virtually impossible. Therefore, the guidelines suggest that the most practical approach to medical waste management is to “identify wastes that represent a sufficient potential risk of causing infection during handling and disposal and for which some precautions likely are prudent.” Wastes targeted for handling and disposal precautions include microbiology laboratory waste (e.g., microbiologic cultures and stocks of microorganisms), pathology and anatomy waste, blood specimens from clinics and laboratories, blood products and other body-fluid specimens.
A single, leak-resistant biohazard bag is usually adequate for containment of regulated medical wastes, according to the guidelines, as long as the bag is sturdy and the waste can be discarded without contaminating the bag’s exterior. If the bag is contaminated or punctured, it should be placed into a second biohazard bag. All bags should be securely closed for disposal.
Transporting and storing regulated medical wastes within facilities prior to terminal treatment is often necessary. This should be done regularly to avoid accumulation. Medical wastes that require storage should be kept in “labeled, leak-proof, puncture-resistant containers under conditions that minimize or prevent foul odors. The storage area should be well ventilated and be inaccessible to pests. Any facility that generates regulated medical wastes should have a regulated medical waste management plan to ensure health and environmental safety as per federal, state, and local regulations.”
Technology has helped make exposure to bloodborne pathogens in the operating room or trauma unit setting less likely. Suction canisters and other fluid-collection devices are designed to inactivate a variety of bacteria, viruses and fungi. Numerous products exist in the marketplace today and include the aforementioned canisters, liner systems, and systems that collect and dispose of fluid into a sewer system. Medical fluid waste management systems are now found throughout the healthcare institution and can be either fixed or mobile systems.
Ticer (2007) describes stationary fluid waste management systems as typically being installed in soiled holding or utility rooms and consisting of a holding bracket for contaminated suction canisters, a tubing component that connects the canister to the waste management system, an actuating lever to start the fluid removal process, as well as optional rinse and disinfection cycle capabilities. These systems are usually connected to the main hospital drain for fluid disposal. Ticer (2007) further describes mobile medical fluid waste management systems as consisting of a cart containing a suction reservoir and vacuum pump located near the point of use. The cart functions as a wall-mounted suction regulator and canister would, including similar use of tubing, vacuum pressure and the monitoring of the reservoir’s capacity. Similar to the stationary systems, the cart-based devices drain, rinse and disinfect their internal reservoirs.
One engineering control system that helps reduce exposure to body fluids is liquid medical waste solidification products. HCWs have benefited from the protection these products provide, including the elimination of spilling, splashing and aerosolization. Other equally effective products for the OR include absorbent polymers in granule form, as well as fluid-control mats and other containment devices.
While many systems are now sealed/closed, impervious systems, care should still be taken by way of donning appropriate personal protective equipment such as masks, gloves and gowns, and following manufacturers’ recommendations when handling and disposing of the canisters to prevent unintentional exposure. It is essential for HCWs to follow standard precautions — an infection control system that assumes that every direct contact with blood and body fluids is a potentially infectious exposure – when handling RMW. This system is based on the premise that not all patients with bloodborne infections have been diagnosed, and therefore, precautions must be applied.
FedCenter.gov. Medical Waste. Summary of Federal Requirements.
Ticer J. Medical liquid waste management. Medical Construction & Design. March/April 2007.