Medical Waste Management in the Bioterrorism Era - PowerPoint PPT Presentation

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Medical Waste Management in the Bioterrorism Era

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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


1
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

2
Objectives
  • After todays conversation, listeners will
  • Know the general categories of regulated medical
    waste
  • 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

3
CDC Guidance on Regulated Medical Waste
  • CDC Guidelines for Environmental Infection
    Control in Health-Care Facilities
  • Full text version December 2003
    http//www.cdc.gov/ncidod/hip/enviro/guide.htm
  • Topics include categories of medical waste,
    treatment, disposal, discharge of blood to
    sanitary sewers, CJD issues, and issues relating
    to on-site decontamination

4
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

5
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
    prudent
  • Microbiology laboratory waste pathology and
    anatomy waste blood, blood products, and other
    body substances sharps
  • States may designate additional categories (e.g.,
    animal wastes)

6
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

7
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

8
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

9
Where Can I Find My States Medical Waste
Regulations?
  • EPA has a link to all the state regulatory web
    pages
  • http//www.epa.gov/epaoswer/osw/stateweb.htm
  • EPA also links to other Federal government
    agencies web pages
  • http//www.epa.gov/epaoswer/other/medical/state

10
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

11
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

12
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

13
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

14
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

15
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

16
Decontamination of Amplified Cultures and Stocks
  • Historically was done in the microbiological
    laboratory via steam autoclaving or on-site via
    incineration
  • 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

17
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
    handling

18
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
    inactivate
  • Any sterilizer is suitable to use

19
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
    methods
  • Transport and chain of custody issues
  • EPA registered chemicals for medical waste
    treatment (List G) http//www.epa.gov/oppad001/che
    mregindex.htm
  • Autoclave operations
  • Infectious waste is not hazardous waste

20
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
    management?

21
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

22
Thank You!
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