Medical Waste Management in the Bioterrorism Era - PowerPoint PPT Presentation


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Medical Waste Management in the Bioterrorism Era


Medical Waste Management in the ... Treatment or decontamination Transport to disposal site Discharge to solid waste landfill Medical Waste Management is Heavily ... – PowerPoint PPT presentation

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Title: Medical Waste Management in the Bioterrorism Era

Medical Waste Management in the Bioterrorism Era
  • Lynne Sehulster, PhD, M(ASCP)
  • Division of Healthcare Quality Promotion
  • Centers for Disease Control and Prevention,
    Atlanta GA

  • After todays conversation, listeners will
  • Know the general categories of regulated medical
  • Be aware of regulations in their state that
    address medical waste management
  • See how the recent influenza A (H2N2) episode
    revealed weaknesses in current waste management
    strategies and
  • Understand the importance of on-site treatment in
    a bioterrorism era

CDC Guidance on Regulated Medical Waste
  • CDC Guidelines for Environmental Infection
    Control in Health-Care Facilities
  • Full text version December 2003
  • Topics include categories of medical waste,
    treatment, disposal, discharge of blood to
    sanitary sewers, CJD issues, and issues relating
    to on-site decontamination

Epidemiology of Medical Waste
  • Syringes on the beach and the AIDS era
  • No evidence that traditional medical waste
    treatment and management processes have
    contributed to increased levels of disease in the
    community and/or healthcare workers
  • Occupational injuries sustained during care
    delivery (i.e., needlesticks) are excluded unless
    the item is already discarded

General Categories of Medical Waste
  • Identify wastes that represent a sufficient
    potential risk of infection during handling and
    disposal and for which some precautions appear
  • Microbiology laboratory waste pathology and
    anatomy waste blood, blood products, and other
    body substances sharps
  • States may designate additional categories (e.g.,
    animal wastes)

Basic Components of Medical Waste Management
  • Discard at point-of-use
  • Collection and consolidation within the facility
  • (Containment and packaging)
  • (Transport to treatment location)
  • Treatment or decontamination
  • Transport to disposal site
  • Discharge to solid waste landfill

Medical Waste Management is Heavily Regulated!
  • Federal government agencies
  • OSHA
  • DoT
  • EPA
  • CDC (guidance but not regulatory)
  • State government agencies
  • Health department
  • Environmental protection department

State Medical Waste Regulations
  • State medical waste regulations address
  • Categories of medical waste
  • Treatment or decontamination of these wastes
  • Consolidation, packaging, and storage on-site
  • Transport and disposal
  • Treatment centers vs. on-site

Where Can I Find My States Medical Waste
  • EPA has a link to all the state regulatory web
  • http//
  • EPA also links to other Federal government
    agencies web pages
  • http//

Treatment of Medical Waste
  • Method of treatment
  • Traditional autoclaving, incineration
  • Chemical immersion
  • Alternative treatment technologies
  • Use conditions
  • Treatment site
  • On-site vs. off-site
  • Off-site locations necessitate transport of
    untreated waste

What Happened?!?
  • Facilities outsourced medical waste management to
    third party waste management firms
  • Regional medical waste treatment centers
  • Decommissioned decontamination autoclaves
  • Labs used disposable items and pre-sterilized
    supplies and reagents
  • Incinerators deactivated emissions

Cluster of Mycobacterial Infections Associated
with Medical Waste Treatment
  • May September 1997 3 cases of TB among
    workers at a regional medical waste treatment
    facility in Washington state
  • Grinding/shedding, electrothermal deactivation
    (radiofrequency oven)
  • Workers who became infected worked with the waste
    prior to the electrothermal deactivation step

Environmental/Occupational Investigation
  • Safety flap in the in-feed chute missing
    blowback phenomenon
  • No decon procedures when leaving the processing
    area confusion about use of protective clothing,
    inconsistent use
  • No reporting of occupational injuries
  • Airline respirators inadequate (NIOSH)
  • No respiratory protection during spills

Microbiological Aspects
  • PFGE-matching of one workers TB isolate to that
    of a patient
  • Lab did not decontaminate the TB culture before
    sending it off-site for medical waste processing

Microbiological Aspects
  • 45 of worker contacts of the 3 case-workers were
    skin-test positive no household transmission, no
    community transmission
  • 49 of WA laboratories ship viable MTB cultures
    to medical waste disposal facilities

Decontamination of Amplified Cultures and Stocks
  • Historically was done in the microbiological
    laboratory via steam autoclaving or on-site via
  • Phased out as other clean needs for autoclaving
    disappeared from the labs
  • Release of live material from lab custody in
    these situations is not considered ethical
  • Transport of live material on your highways

Decontamination of Amplified Cultures and Stocks
  • Inappropriate method for decontamination (e.g.,
    never use an aerosol-generating method when
    airborne pathogens are present)
  • Aerosol containment devices and procedures failed
    during operation at the WA facility
  • First instance of infections due to medical waste

Influenza A (H2N2) in 2005
  • CDC advises hospitals to destroy virus via
    autoclaving or incineration
  • Many hospitals attempt to use the clean
    autoclaves in central sterile prep. dept.
  • Labs attempt chemical decontamination
  • Incorrect assumptions at work
  • Pandemic strain must be more difficult to
  • Any sterilizer is suitable to use

Weaknesses in Medical Waste Management Processes
  • Labs lack the capacity to do decon on-site
  • Lack of awareness of key information
  • State regulatory process and recommended decon
  • Transport and chain of custody issues
  • EPA registered chemicals for medical waste
    treatment (List G) http//
  • Autoclave operations
  • Infectious waste is not hazardous waste

Disposal of Agents of Bioterrorism
  • Prepare in anticipation that your lab will be
    asked to culture and identify a BT agent
  • How will facilities that lack decon capacity now
    be able to treat / dispose BT agents?
  • What is your states plan for management of
    discarded BT agent cultures, etc.?
  • Laboratory Response Network (LRN)
  • Release untreated materials to third party waste

Restore the Capacity of In-Laboratory
Decontamination of Stocks and Cultures
  • AIA construction guideline, 2001 (7.12.G)
  • CDCs EIC guideline (Category II), 2003
  • CDCs Select Agent Rule, 2003
  • ASM / American Academy of Microbiology
    endorsement, 2001
  • Bioterrorism concerns
  • Influenza A (H2N2) episode, 2005

Thank You!