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1
Environmental Services Professional Training
Course
2
Morning Schedule
(15 min.) Introductions (15 min.) Course
Development and Objective, Pre-test,
Overview of Occupational Hazards,
Definitions (60 min.) Microorganisms
Infectious Agents (show 27 min. video
before lecture/discussion) (15 min.)
Break (75 min.) Infectious Waste (includes 22
min. video)
3
Morning Schedule
(40 min.) Cleaning for Health (50 min.)
Lunch
4
Afternoon Schedule
(40 min.) Hazardous Material Safety
(40 min.) Needlestick and Injury Prevention
(15 min.) Break (30 min.) Spill Response
(60 min.) Regulated Medical Waste
Transportation Requirements (45 min.) Post
Test and Course Evaluations
5
Course Objective - to provide environmental
services professionals with the information they
need to do their jobs safely.

• Occupational hazards associated with handling
  infectious waste, disinfecting contaminated
  surfaces, and responding to infectious materials
  incidents
• Infection control on the job
• Material Safety Data Sheets and hazards
  associated with the use of chemical disinfectants

6

• Selection of proper personal protective
  equipment
• Housekeeping and spill response procedures
• The American Hospital Associations infectious
  waste reduction initiative sponsored by the EPA
• Requirements for packaging and transporting
  infectious or regulated medical waste

7
Occupational Hazards
8
1.0 Overview of Occupational Hazards
When they enter patient rooms, they may become
exposed to infectious diseases.
They risk exposure to bloodborne pathogens from
dirty needles that are occasionally thrown away
in the biohazard and general waste streams.
9
They work with chemicals that are often corrosive
and dangerous if not handled properly.
They are a category of worker at risk of latex
allergy from ongoing latex exposure.
They may become injured from slips, trips, and
falls, or heavy lifting.
10
Microorganisms Infectious Agents
11
2.0 Microorganisms Infectious Agents
1. Bacterial agents - Tuberculosis (TB),
Staphylococcus (staph), or Legionella 2. Fungal
agents - Aspergillus (mold), Tinea (ringworm) 3.
Viruses - Hepatitis B, Hepatitis C, HIV 4.
Parasitic agents - Giardia and Trichomoniasis 5.
Prions - Kuru and Creutzfeldt-Jakob Disease 6.
Rickettsial agents - Rocky Mountain spotted fever
and Lyme Disease
12
In order for an infectious agent to make a person
sick, it must first come into contact with that
person. This contact is called an exposure.
EXAMPLE 1 - Tuberculosis
13
In a 1995 publication, CDC researchers reported
the results of a study that found the annual risk
of contracting TB was higher for hospital
housekeepers than nurses.
EXAMPLE 2 - Hepatitis B
14
There are two ways to reduce the rate of HBV
transmission from needlestick injuries and they
are 1) To get a Hepatitis B vaccination
2) To report all needlestick injuries to the
infection control nurse and accept post-exposure
treatment.
15

• Environmental services professionals can prevent
  the spread of infectious agents among patients
  and healthcare workers by protecting themselves
  in the following ways
• Wearing puncture resistant gloves while
  handling any form of hospital waste to include
  biohazard bags, infectious waste containers, and
  trash bags of any color

16

• If puncture resistant gloves are worn, wash
  gloves between patient rooms to avoid transfer of
  microorganisms from one patient to another
• Wear proper personal protective equipment when
  cleaning up spills of potentially infectious
  material
• Use an antibacterial soap to wash gloves
  immediately after contact with blood and/or body
  fluids, soiled linen, or contaminated equipment

17

• Immediately report needlestick and other
  sharps-related injuries to the infection control
  staff

• Follow any recommendations made by the
  infection control staff after a potential
  exposure to prevent infection
• Follow recommended infection prevention
  practices to include receiving the hepatitis B
  vaccination

18

• Participate in OSHA bloodborne pathogen
  training
• Wash hands immediately after removing gloves

• Wash hands before and after eating, smoking,
  applying cosmetics, or preparing food
• Stay home to rest when feverish and sick with a
  cold, flu, or other infection

19
Infectious Waste
20
3.0 Infectious Waste

• Isolation wastes are those made in isolation
  rooms where patients with infectious diseases are
  cared for.

• Cultures and stocks are wastes generally made
  in the laboratory and may include specimen
  cultures, discarded vaccines, culture dishes, and
  devices used to transfer, inoculate, and mix
  cultures.

21

• Human blood and blood products are wastes that
  can be found anywhere in the health care facility
  but most often they are found in the laboratory,
  operating rooms, and labor and delivery areas -
  these wastes include blood, serum, plasma, and
  other blood products.
• Pathological wastes are wastes generally found
  in the pathology labs and autopsy suites - these
  wastes include tissues, organs, body parts, and
  body fluids that are removed during surgery and
  autopsy.

22

• Contaminated sharps are wastes that can be
  found in areas where patients are treated and the
  laboratory - these wastes include hypodermic
  needles, syringes, glass pipettes, broken glass,
  and scalpel blades.

• Contaminated carcasses, body parts, and bedding
  are wastes that can be found in a medical
  research laboratory where animals are exposed to
  infectious microorganisms.

23

• Miscellaneous wastes are those items that are
  probably contaminated with infectious
  microorganisms - they include contaminated
  materials found in the dialysis units, surgery
  and autopsy suites, and laboratory areas.
  
• If an item has come in to contact with blood or
  body fluids, it is considered contaminated and
  probably infectious, therefore, it should be
  treated as infectious waste.

24

• All infectious waste must be disposed of properly
  in accordance with a federal law known as the
  OSHA Bloodborne Pathogens Standard. Proper
  disposal means the following
• All needles and other contaminated sharps must
  be placed in a closable, puncture-resistant,
  leakproof, red or biohazard-labeled container.
• All other infectious wastes must be placed in
  closable, leakproof, red or biohazard-labeled
  bags or containers.

25
Biohazard Label
Red Bag
Biohazard Labeled Bag or Container
26
Hospitals produce approximately two million tons
of solid waste per year. Of this amount, ten to
fifteen percent is categorized as infectious and
the rest is general waste made up of paper and
paper board, plastics, food waste, metal, glass,
wood and other materials. All of the solid waste
is sent to landfills or incinerators for
disposal.
27
If 100 of hospital solid waste is disposed of
in red bags...
Only about 10 of the waste is actually
infectious ...
And 2 of the waste is pathological, requiring
incineration.
28

• According to the EPA, medical waste
  incinerators are the fourth largest known
  releasers of mercury to the environment.
• Mercury waste is being improperly disposed of
  in biohazard bags along with other solid wastes
  that are not considered infectious.
• Mercury cannot be destroyed by incineration.
• Thirty nine states have issued over 1,600
  warnings against eating mercury contaminated fish
  found in their waterways.

29
Because of all of the environmental health
problems caused by medical waste incinerators,
the American Hospital Association and the EPA
have reached an agreement to work together to
reduce the amount of waste within the hospital
system by half by the year 2010. A number of
actions can be taken to reduce the amount of
solid waste within the hospital system that is
sent in biohazard bags to medical waste
incinerators for disposal.
30

• Work with hospital administrators to develop
  policies that support biohazard bag reduction
  efforts.
• Provide information to all hospital staff about
  the toxic contaminants created by medical waste
  incineration.
• Educate staff about different categories of
  infectious waste and teach them to place only
  infectious wastes in biohazard bag containers.

31

• Place and maintain biohazard bag containers
  only in those areas where infectious wastes are
  likely to be made.

• Place and maintain special biohazard-labeled
  containers in areas where pathological wastes are
  likely to be made and teach staff to only place
  pathological wastes in them.

32

• Keep pathological wastes separate from the
  other infectious wastes.
• Send only pathological wastes to a medical
  waste incinerator for disposal.
• Make alternative arrangements to properly treat
  and dispose of all other infectious waste (e.g.
  autoclaves, microwaves, chemical treatment).

33
Cleaning for Health
34
4.0 Cleaning for Health

• The goal of a health care facility cleaning
  program is to prevent the spread of infectious
  agents among patients and healthcare workers and
  to maintain a healthy indoor environment. A
  healthy indoor environment is one that is free of
  hazardous pollutants.
• Organic Pollutants - chemical compounds such as
  formaldehyde, pesticides, and disinfectants
• Inorganic Pollutants - particles such as
  asbestos and lead

35

• Radiation - pollutants include both ionizing
  (e.g. radon) and non-ionizing (e.g.
  electromagnetic fields) types.
• Complex Mixtures - examples include soot and
  tobacco, both of which contain organic and
  inorganic matter.
• Biological Contaminants - referred to as
  bio-pollutants. Examples include bacteria,
  viruses, algae, fungi, ragweed, mites.
• Biological contaminants are the most hazardous
  pollutants found in the indoor healthcare
  facility environment.

36
They are living organisms, or come from living
organisms, and can be found under certain
environmental conditions 1. There must be a
comfortable home or reservoir in which to hang
out which is just about anyplace, and 2. They
need nourishment just like us in the form of food
and water. What kind of food do these organisms
eat?
37
Aspergillus is a fungus found in dust and is an
example of a common biological contaminant that
lives well in soil, water and decaying material.
In health care facilities, it may be found
in the building ventilation system in areas where
organic matter (dust) and water are present.
Where would you expect to find this organism in a
health care facility? Can this organism kill a
patient?
38
Another deadly biological contaminant found in
the healthcare facility is a bacteria named
Vancomycin-resistant enterococci. (VRE). The
reason why this bacteria is deadly is because it
cannot easily be killed by antibiotics and many
patients die once they become infected with it.
How do you think patients become infected with
this bacteria?
39
If someone comes into the hospital carrying the
VRE bacteria, then whatever that person touches
may become contaminated with VRE. Deadly VRE can
survive for weeks on environmental surfaces.
Patients may become infected with VRE by
touching contaminated surfaces such as bedrails,
sinks, faucets, and doorknobs, or coming into
contact with health-care workers who do not wash
their hands.
40
Environmental services professionals play a key
role in controlling the spread of VRE throughout
the healthcare facility by washing hands and
wearing gloves properly, and diligently cleaning
and disinfecting all environmental surfaces.
41
Surfaces with regular hand-contact are called
high touch surfaces. High touch surfaces in
patient care areas include items such as
telephones, doorknobs, bedrails, light switches,
faucets, and wall areas around the toilet. These
surfaces must be cleaned and disinfected daily
to protect the patient and reduce the spread of
nosocomial diseases such as VRE. Nosocomial
diseases are illnesses that patients acquire
during their stay in the hospital.
42
Clostridium difficile
43
The primary goal of a health care facility
cleaning program is to prevent the spread of
nosocomial disease among patients and healthcare
workers. Environmental services professionals
play an important role in achieving this goal.
Daily cleaning reduces the amount of
microorganisms in the patient care environment.
44

• Suggestions for improving the general cleaning
  and disinfecting process
• When selecting a disinfectant for use, choose
  the least toxic and most effective cleaning
  product you can find.
• Always clean from least soiled to more soiled
  areas and from top to bottom in the patient
  rooms.
• Always change the disinfecting solution when it
  appears dirty (usually after every 3-4 patient
  rooms).

45

• Use a clean cloth or mop head each time a
  bucket of detergent/disinfectant is emptied and
  replaced with fresh, clean solution.
• Dusting reduces potential food for Aspergillus
  and prevents infection in hospitalized patients
  and allergies in employees.
• Dust can be removed without making patients
  sick by using a chemically treated cloth/mop or a
  cloth dampened with approved disinfectant.

46

• When dusting, it is important NOT to shake the
  cloth/mop because dust and fungal spores will
  then get in the air. If patients breathe in
  these spores, they may get sick and die.
• While dusting ceilings and vents, report any
  stains and/or wet areas immediately for repair.
  Fungus will start to grow on wet ceiling tiles
  within 72 hours.
• Special care areas need additional attention.
• What are special care areas?

47

• Process improvement for special care areas
• Use a bucket method for cleaning each special
  care area, where a clean cloth is dipped into a
  bucket filled with approved disinfectant and
  items are cleaned and left wet for ten minutes.
• Daily cleaning should include the washing and
  disinfecting of walls around light switches,
  doorknobs, and other high touch surfaces.
• Use CLEAN mops and CLEAN mop water for cleaning
  and disinfecting the floor in each special care
  or isolation room.

48

• When a patient is discharged from a special
  care area, throw away all disposable items,
  change any cubicle curtains, and disinfect all
  surfaces including chairs, tables, ledges, call
  lights, telephones, sinks, showers, and toilets.
• Avoid the use of cleaning equipment that
  produces mists.
• If a vacuum is needed to clean the floor in a
  special care area, use one with a clean HEPA
  filter on the exhaust. Keep the door to the
  special care area closed when vacuuming.

49
It can not be emphasized enough. Environmental
services professionals play a key role in
preventing the spread of infectious agents among
patients and healthcare workers. Diligent
housekeeping keeps microorganisms and other
bio-pollutants under control and reduces the
spread of nosocomial disease. What is
nosocomial disease?
50
Hazardous Material Safety
51
5.0 Hazardous Material Safety
Environmental services professionals routinely
use chemical disinfectants to clean surfaces and
kill infectious agents in patient rooms and other
areas of the health care facility. If not
handled properly, these chemicals can cause
serious injuries such as eye damage, respiratory
problems, chemical burns, or severe skin
irritation. To prevent such injuries, the OSHA
Hazard Communication Standard requires all health
care employers to provide information and
training to their employees about the hazards
associated with the chemicals in their workplace.

52

• Employers must provide training to their
  employees on the following topics
• Ways or how to detect the presence or release
  of a hazardous chemical in the workplace
• The physical and health hazards of the
  chemicals in the workplace and the measures that
  can be taken by environmental services staff to
  protect themselves from these hazards, including
  safe work practices, emergency procedures, and
  personal protective equipment to be used

53

• The facilitys hazard communication labeling
  system, the hazard information provided by the
  MSDS, and how personnel can obtain and use the
  hazard information on the MSDS

In order to understand the hazard information
provided by the MSDS, environmental services
professionals must first learn something about
the nature of chemicals. Chemicals are made up
of single or multiple elements.
54
Oxygen - one element, two molecules of oxygen
(02) Water- two elements, two molecules of
hydrogen and one molecule of oxygen (H20) The
most common chemicals in use are made up of three
elements - carbon, hydrogen, and oxygen. What
are some chemicals used everyday in healthcare
facilities?
55
Chemicals also come in different forms - solids,
liquids, gases, or vapors, and can even be
radioactive.
H-3, also known as Tritium, is an example of a
radioactive material which is made up of three
hydrogen molecules. It is often used by
scientists in biomedical research laboratories.
56
Chemicals change from one form to another
depending on temperatures and pressures. Water
turns to ice when the temperature drops below 32
degrees F. When water is heated to the boiling
point, it evaporates and turns into a vapor.
Some chemicals evaporate at or below room
temperatures becoming airborne vapors. Gasoline
is a common chemical that becomes an airborne
vapor at and below room temperature. It is very
flammable with a flash point of -45 degrees F.
57
In addition to being flammable, gasoline vapors
are very dangerous because they are harmful to
human health. Any chemical can be harmful to
human health. How harmful a chemical is depends
on how much of it gets into the body and how
toxic it is.
58

• Chemicals can enter the body in one of four ways
  
• They can be inhaled (breathed in)
• They can be ingested (swallowed)
• They can be absorbed through the skin or eyes
  or
• They can be injected.
• When a chemical enters the body, an exposure has
  taken place. The effects of the exposure can be
  either sudden or long term.

59
Example The effects of formaldehyde exposure
can either be sudden or long term. Formaldehyde
is both corrosive and a suspected carcinogen.
It is very important to wear Personal Protective
Equipment (PPE) when working with corrosive
material.
60
OSHA has set guidelines for safe levels of
exposure to many airborne contaminants including
mists, gases, vapors, dusts, and fibers. These
are known as Permissible Exposure Levels or PELs.
The American Conference of Governmental
Industrial Hygienists (ACGIH) has also set
guidelines for safe levels of exposure to many
contaminants. These are known as Threshold Limit
Values or TLVs. If a safe exposure level has
been identified by OSHA or the ACGIH for a
particular material, then it will be provided on
the MSDS.
61
Unsafe levels of exposure may occur in the work
place at any time in the event of a spill or
release of a hazardous material. It is therefore
very important that workers know where hazardous
materials are stored or used and how to detect a
spill or release in their work place. Some
hazardous materials have warning properties that
alert the worker to a potential exposure in the
event of a release. Examples of warning
properties include odor, headache, burning or
tearing eyes, or coughing.
62
Not all hazardous materials have warning
properties and in some cases the warning
properties do not occur until after the employee
has been exposed to a dangerous amount of
material. In such cases, employers may install
alarm systems that go off when levels of exposure
are immediately dangerous to life and health.
Example Ethylene oxide is a toxic gas that is
used in many healthcare facilities to sterilize
surgical instruments. It is considered a
carcinogen and a reproductive hazard.
63
Some hospitals have eliminated the use of
ethylene oxide altogether. They have found a
less hazardous material to use in their
sterilizers. Using a less hazardous material to
do the same job is known as substitution. If a
substitute material cannot be found to do the
job, a toxic or other hazardous material can be
used safely in the work place as long as
precautions and procedures are in place to
protect the worker from exposure.
64

• Safe work practices or precautions for using a
  particular chemical may be found in the MSDS or
  on the product label. Below are some common
  precaution statements found on product labels
• Use with adequate ventilation
• Keep away from sources of ignition (e.g. heat,
  flame)
• Wear chemical splash goggles
• Wear rubber gloves to avoid skin contact.

65
The MSDS will state what type of PPE the worker
needs to wear to prevent exposure while handling
the material. If an exposure does occur, the
MSDS also provides health hazard and emergency
first aid information. To summarize,
manufacturers must develop a Material Safety Data
Sheet (MSDS) and provide it to people and
organizations that purchase their products.
Employers such as hospital organizations are then
required to train their employees on the hazard
information provided by the MSDS.
66
Needlestick and Injury Prevention
67
6.0 Needlestick and Injury Prevention
It is estimated that 600,000 to 800,000
needlestick and other percutaneous injuries occur
annually among health care workers in the United
States. About half of these injuries go
unreported. Data suggests that at an average
hospital, approximately 30 needlestick injuries
occur per year for every 100 beds. How many
beds are in the hospital that you work at?
68

• Of the reported needlestick injuries,
  approximately 41 occur for the following
  reasons
• Improperly disposed sharp
• Disposal-related causes
• Collision with health care worker or sharp and
• Cleanup.

69

• To reduce the risk of needlestick and other
  injuries, the following control measures are
  recommended to protect the environmental services
  professional
• Always wear whatever personal protective
  equipment is necessary to do the task safely to
  protect your skin, work clothes, and mucous
  membranes from contact with potentially
  infectious materials (e.g. gloves, masks, face
  shields, gowns, and aprons).
• A gown or apron should be worn if there is a
  possibility of contact with infectious materials
  on your work clothes.

70

• A mask and goggles or eye protection should be
  worn if there is a possibility of contact with
  infectious materials in your eyes, nose, or
  mouth.
• Gloves should be worn to protect your hands
  from contact with chemicals and potentially
  infectious materials.
• Wear puncture resistant gloves when performing
  high risk tasks (e.g., changing out needle boxes,
  cleaning up broken glass, handling infectious
  waste containers).
• Report to management any needles or other sharp
  items not properly disposed of by the health care
  providers.

71

• Locate puncture resistant leak-proof containers
  for sharps and needle disposal in areas where
  they are convenient and likely to be used by
  health care providers.
• Ensure that sharps and needle disposal
  containers are emptied before they become full.
• Report to management any sharps containers that
  are mounted too high or are not easily accessible
  to health care providers.

72

• Use a brush and dust pan to pick up broken
  glass which may be contaminated with blood or
  other body fluids.
• Handle contaminated laundry including sheets as
  little as possible. Do not shake out these
  items. Hold them away from your body and place
  in the linen hamper without pressing down on
  them.
• Carry red bags or other containers of medical
  waste away from your body.
• When cleaning up contaminated areas, minimize
  splashing, spraying, and spattering.

73

• Bandage any cuts on your hands before putting
  on gloves.
• If latex gloves are worn, always wash and
  remove them after cleaning a patients room or
  any other potentially contaminated area.
• Dirty gloves should never be worn after the
  cleaning job is done - wearing them around the
  hospital contaminates surfaces and spreads
  disease among the patients.
• Always wash hands after removing gloves and
  whenever they are dirty.
• Always wash hands in between patient rooms.

74

• Follow safe work practices (e.g., do not eat,
  drink, smoke, apply lip balm, or handle contact
  lenses where there might be exposure to blood or
  other potentially infectious materials).
• Keep food and drinks away from areas where
  blood or other potentially infectious materials
  are present.
• Report needlestick injuries and other potential
  bloodborne pathogen exposures to the infection
  control staff at your health care facility.

75

• Follow any recommendations made by the
  infection control staff after a potential
  exposure.
• Ask the infection control staff at your health
  care facility about the free Hepatitis B vaccine
  that is provided to environmental services
  professionals

76
Spill Response
77
7.0 Spill Response
Environmental services professionals routinely
respond to calls for assistance in cleaning up
spilled materials on the patient wards and other
areas of the hospital. The spilled materials
often consist of human body fluids such as urine,
blood, and feces that may or may not be
infectious. Regardless of whether or not the
material is actually infectious, any human body
fluid must be considered potentially infectious.
78

• The environmental services professional should
  receive training on the following topics
• The health care facility emergency response
  plan for hazardous materials spills (e.g.
  notification, personal protective equipment
  (PPE), spill response and equipment maintenance
  procedures, etc)
• The different types of micro-organisms
  potentially found in their workplace to which
  they are susceptible (e.g. E. coli, MRSA, VRE)
  along with definitions and symptoms of exposure

79

• Spill site security and control
• The measures that environmental services
  professionals can take to protect themselves to
  minimize their risks of exposure during cleanup
  operations to include wearing proper PPE
• Contaminated surface cleaning procedures
• Disinfectant selection and effective
  decontamination procedures
• Proper disposal procedures for potentially
  infectious waste materials

80

• Removing PPE, decontamination and/or disposal
  procedures and
• The health care facility exposure control plan
  for bloodborne pathogens and employee health and
  medical surveillance program.
• Do environmental services professionals require
  special training to clean up hazardous material
  spills in the hospital environment?
• Depends on whether or not the spill is considered
  incidental.

81
An incidental spill is a release of hazardous
material which does not have the potential to
become an emergency within a short time frame.
Incidental releases are limited in quantity,
exposure potential, or toxicity and present minor
safety or health hazards to employees in the
immediate work area or those assigned to clean
them up. An incidental spill may be safely
cleaned up by an employee who is familiar with
the hazards of the material. It is up to
management personnel to decide whether or not a
spill is incidental.
82
(No Transcript)
83
Medical Waste Transportation
84
8.0 Regulated Medical Waste Management,
Disposal, and Transportation Requirements
There is a great deal of concern about the proper
management of health care facility wastes.
Environmental services professionals are
responsible for picking up the waste at each
point of generation and transporting it to the
designated place of disposal or storage at the
facility. If certain wastes are mishandled or
improperly disposed of, health care facilities
may be subject to fines. Some of the waste
generated in the health care setting could be
infectious and transmit disease if improperly
handled or disposed of.
85

• It is important that environmental services
  professionals receive training on the following
  topics
• The health care facility waste management plan
• The different types of waste streams at the
  facility for which they will be responsible
• The definition and/or designation of infectious
  waste including where it is likely to be
  generated and how it is to be segregated from the
  other waste streams

86

• Proper segregation, containment, and labeling
  of wastes in the health care facility

• Department of Transportation (DOT) shipping
  regulations for infectious and/or regulated
  medical waste transported off-site for
  treatment/incineration

87

• State or local regulations for medical and/or
  infectious waste disposal

OSHA regulates infectious waste in the workplace
by enforcing the requirements of the Bloodborne
Pathogens Standard. When environmental services
professionals pick up infectious waste at each
point of generation in the healthcare facility
and transport it to the designated place of
treatment or storage at the facility they must do
so in accordance with OSHA regulations. What
does this mean?
88
The infectious waste may or may not be treated
on-site at the health care facility prior to
shipment off-site for final disposal. If the
waste is treated on-site at the facility so that
it no longer poses the hazard of an infectious
substance, then it is no longer considered
infectious and may be transported off-site as
general waste to a solid waste disposal facility
(e.g. landfill, transfer station) regulated by
state or local authorities.
89
If the waste is not treated on-site, then it is
considered infectious and a DOT hazardous
material, and it must be transported off-site in
accordance with DOT shipping regulations for
hazardous materials. DOT regulations require that
all infectious substances, including regulated
medical waste, be prepared for shipment off-site
by trained personnel. Specifically, personnel
must receive initial and recurrent training
(every two years) that meets the DOT training
requirements in three subject areas.
90
1. General awareness/familiarization training
to enable the employee to recognize and identify
regulated medical waste as defined by DOT DOT
Definition of Regulated Medical Waste - a waste,
or reusable material, that contains an infectious
substance and is generated in the diagnosis,
treatment, or research of humans or animals
2. Function-specific training to familiarize the
employee with the DOT shipping requirements
related to the job that he/she performs
91
3. Safety training concerning the specific
hazards associated with regulated medical waste,
safe handling of packages containing regulated
medical waste, and the emergency response
procedures and information required by DOT for
every regulated medical waste shipment in the
event of an accidental release. DOT requires that
personnel be tested after receiving the training
on the three subject areas.
92
A record of current training must be kept by the
health care facility for each employee that
prepares regulated medical waste for shipment
off-site to a treatment facility. Each record
must include the employees name, the most recent
training date, a copy of the training materials,
the name and address of the trainer, and a
certification that the employee was trained and
tested.
93
In accordance with DOT shipping regulations,
regulated medical waste must be shipped in
packages that are properly labeled and marked
(see DOT brochure).
A shipping paper must also be prepared for every
regulated medical waste shipment that leaves the
health care facility.
94
A description of the regulated medical waste
shipment must be included on the shipping paper
as well as the name of the health care facility
and an emergency response telephone number.

• The description of the waste shipment on the
  shipping paper must include
• The proper shipping name, Regulated Medical
  Waste
• The hazard class, 6.2
• The identification number, NA 3291 and
• Packing group, II.

95
The total quantity of the medical waste being
shipped off-site for treatment must also be
entered on the shipping paper (see example). It
is important for environmental services
professionals to understand that untreated
regulated medical waste is considered an
infectious substance and a DOT hazardous
material. It must be transported from the health
care facility in accordance with DOT shipping
regulations.
96
If untreated regulated medical waste is
improperly disposed of in the general solid waste
stream and transported off-site to a transfer
station or landfill, the healthcare facility will
be subject to fines levied by the local
government and the federal DOT. 25,000.00