Waste Management Training
In the Clinical Setting
Biohazardous Waste Reduction
Training
Waste Issues on the
UNMC/Nebraska Medical Center
campus
Comparison Cost and Pounds by Quarter
186,000
$41,000.00
184,000
$40,500.00
182,000
$40,000.00
Pounds
180,000
$39,500.00
178,000
$39,000.00
176,000
$38,500.00
174,000
172,000
$38,000.00
1st Q
2nd Q
3rd Q
Quarter of 2001
4th Q
Pounds
Cost
In 2001, Administration
noted that there was a
growing discrepancy
between what they were
paying to have campus
biohazardous waste
removed, and the
number of pounds
generated. In an
attempt to control
biohazardous waste
costs, Administration
requested that a
committee be formed to
address the issues of
biohazardous waste on
campus.
In August 2001, the Biohazardous Waste Committee was formed. The mission
of the committee is to reduce biohazardous waste on the UNMC/Nebraska
Medical Center campus (and its affiliates).
One of the first tasks addressed by the Biohazardous Waste Committee was to
reduce confusion regarding biohazardous waste by creating one campus-wide
definition for biohazardous waste. Up until the time the new definition was
formed, depending on where an employee worked on campus, they had a
different definition of biohazardous waste and policies and procedures to
adhere to regarding handling and preparing waste for shipping. Now the
definition of biohazardous waste is the same no matter where an employee is
located in the facility. Policies and procedures have also been standardized so
that practices of handling and preparing biohazardous waste are the same
everywhere on campus. In order to inform employees of the new changes in
the definition, policies and procedures of biohazardous waste, the
Biohazardous Waste Committee also developed educational programs and
materials to train employees on biohazardous waste reduction.
Issues regarding generation of biohazardous waste still needed to be
addressed, and the Biohazardous Waste Committee set out to determine those
areas that generated the largest amounts of biohazardous waste. By
consulting with EVS management, several large generators of biohazardous
waste were identified. The committee also conducted a biohazardous waste
audit in October of 2002 to determine what was being placed in our
biohazardous waste containers. What follows are some pictures from that
waste audit:
Large amounts of laundry
were found in red
containers.
Red containers also contained many assorted items that are not included in the
definition of biohazardous waste.
Many containers held paper towels and empty toilet paper rolls.
In April of 2004, a biohazardous waste audit was conducted
in the research areas. Numerous inappropriate items were
identified in the biohazardous waste.
The October biohazardous waste audit was successful in identifying areas
generating large amounts of biohazardous waste. It also revealed that
approximately 90% of the waste found in red containers on the docks did not
contain biohazardous waste. The April ’04 waste audit of the UNMC areas
reflected essentially the same results as the October ’02 audit. It became
obvious that the campus was in need of education regarding biohazardous
waste in order to reduce the waste created through improper disposal.
Definition of Biohazardous
Waste
• Biohazardous waste is that
waste that is capable of
producing an infectious
disease in humans and
includes at a minimum blood,
body fluids, discarded sharps,
inoculated culture media,
tissues and slides.
• Biohazardous waste includes
the following categories:
• Blood and body fluids
• Infectious Sharps waste
• Laboratory waste
• Medical sharps
• Some isolation waste
• Some animal waste
Blood and Body Fluids Includes:
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Blood/Blood Products
Serum,
Plasma
Other blood components
Body Fluids
Semen
Vaginal secretions
Cerebrospinal fluid
Pleural fluid
Peritoneal fluid
Pericardial fluid
Amniotic fluid
Any other body fluid visibly contaminated with blood
Does NOT Include
Urine, unless visible blood is present
Feces, unless visible blood is present
Vomit, unless visible blood is present
Blood and Body Fluids
• In order for blood and body fluids to be considered
biohazardous, they must also be present in pourable,
dripable amounts. A pourable quantity is defined as the
ability of a liquid or semi-liquid form to drip or flow. Items
caked with dried blood or other body fluids and are
capable of releasing these materials during handling are
considered biohazardous as well. If you can squeeze
and item and squeeze blood or body fluids out of it, or if
once the items is dry, you can pull it taught and small
flecks of dried blood or bloody fluids can flake off of it, it
is considered to be biohazardous.
Examples of Biohazardous vs.
Non-biohazardous Waste
What’s Biohazardous:
Bottles of blood or
body fluids are
considered
biohazardous. This
fluid is probably
pleural fluid.
Examples of Biohazardous vs.
Non-biohazardous Waste
What’s Biohazardous:
This lab waste is
considered
biohazardous.
In lab situations, where employees are working with concentrated organisms,
culture plates, gloves used to handle them and towels that they sat on are all
considered to be biohazardous.
In non-laboratory situations, gloves are considered biohazardous only if they
have blood on them and towels are biohazardous only if they have blood or
body fluids on them that is in pourable/dripable amounts.
Examples of Biohazardous vs.
Non-biohazardous Waste
What’s Non-biohazardous:
Unused suction
canisters, unused
dressing materials and
dry paper products are
not considered
biohazardous waste.
The blood on this towel is not considered biohazardous. The blood is well contained
within the fibers of the towel, and will not fleck off if the towel is pulled taught.
Other Inappropriate Waste
This red container was returned by our waste vendor, Stericycle, because it contains an
aerosol can. Biohazardous waste undergoes both heat and pressure as part of the
process that renders biohazardous waste non-infectious. Aerosol cans, even if empty,
can act as a small bomb if placed under these conditions, creating a very unsafe
condition for Stericycle employees handling this waste. Aerosol cans must NEVER go in
biohazardous waste. If you are unsure of how to dispose of an aerosol can, consult the
Safety Office for assistance.
Disposing of Suction Canisters
• Suction canisters
containing blood or other
body fluids must be
carefully emptied using a
system that has been
approved by Facilities
Management and
Planning and the
Campus Safety Office or
sealed and placed in
rigid, reusable
biohazardous waste
containers.
Disposing of Suction Canisters
• Personnel must wear appropriate protective
equipment to minimize exposure to potential
pathogens when handling and/or emptying
suction canisters
• Contents may be solidified and discarded
using approved methods if emptying
contents is not practical
• Empty suction canisters must be handled
and discarded as infectious waste
Contaminated Equipment and
Linen
• Equipment and linen contaminated with
infectious material or biological agents
must be handled and decontaminated in
accordance with the guidelines
established in the UNMC/Nebraska
Medical Center Bloodborne Pathogen
Exposure Control Policy
Equipment and Linen
• Equipment and Linen ARE NOT Thrown Away
as a Biohazard!
• Linen saturated with blood and/or other body
fluids should be contained by wrapping it with
other used linen and placed with other dirty
laundry. Our laundry vendor is capable of
removing many stains that might seem
impossible to clean out of linen. Once it has
gone through the cleaning process, appropriate
personnel will determine if an item must be
discarded due to contamination.
Equipment contaminated with blood or body fluids is to be wiped off with a
low level disinfectant. If blood or body fluids have leaked into the machinery,
place a biohazard label on the piece equipment and indicate on the label
where you think blood or body fluids have leaked into the mechanism. Call
Biomed to have the equipment serviced.
Infectious Sharps Waste
• All discarded items derived from human
patient diagnosis, care or treatment, or
items from animals infected with zoonotic
disease in medical or research facilities
which could potentially transmit disease
via direct subdermal (beneath the skin)
inoculation are considered to be
biohazardous.
Infectious Sharps Waste
• Infectious Sharps Waste includes the following
items that have been contaminated with infectious
materials:
• Hypodermic needles
• Scalpels
• Pipettes
• Breakable containers
• Glass products (i.e., slides or cover skips)
Medical Sharps
• Medical sharps waste includes needles and syringes
used in patient care and have become contaminated
with blood or body fluids. Needles and syringes NOT
used in patient care and do not have blood or body
fluids on them are also considered biohazardous
waste as there are safety concerns regarding their
disposal.
While it may sound contradictory to dispose of suction canisters, needles and
syringes that are not contaminated with blood or body fluids, it is a necessary
safety precaution for those individuals handling such items further down the
waste stream. Environmental Services personnel or other waste handlers who
sustain injury while handling such waste will look in the waste bag to identify
what may have caused their injury. If a leaking suction canister, needle or
syringe is visible, the worker will assume that they had a blood/body fluid
exposure, and will need to go through post exposure prophylaxis treatment.
Handling all suction canisters, needles and syringes as though they are a
biohazard can help prevent unnecessary concern and treatment from these
types of “exposures”.
Sharps Waste
All sharps containers must meet
campus Safety Office stands (i.e.,
leak-proof, puncture resistant, etc.)
If there is any question as to
whether or not a sharps container
meets acceptable standards,
contact the Safety Office (5597315), and an officer will examine
the container to assure that it
meets minimal safety standards.
Containers must be sealed when they are approximately ¾ full and placed
with the biohazardous waste for pick up and disposal. NEVER place sharps in
a sharps container once it is beyond ¾ full, as there is a good chance that the
sharp may bounce out of the container and cause injury.
Sharps containers should be bagged and sealed as outlined above if they
contain liquids in the form of blood, bloody fluids or medications. Bagging
sharps containers appropriately when they contain liquid biohazardous
substances helps to contain these fluids in the event that the container should
tip over during handling, storage or transport.
Isolation Waste
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Waste generated from
isolation is not
considered infectious
unless it meets the
definition of infectious
waste as defined by:
Blood and body fluids
Infectious sharps waste
Laboratory waste
Medical sharps waste
Isolation Waste
• Isolation waste is considered infectious if it falls into
one of the following categories:
– Waste within the definitions of laboratory, blood and bloody
fluid or sharps waste
– Waste from patients diagnosed as having a highly
communicable disease caused by the class IV etiological
agents defined by Centers for disease control
Laboratory Waste
Laboratory waste includes all cultures and stocks of infectious agents,
including specimen cultures from medical and pathological laboratories. It
also includes wastes from the production of biologicals, discarded live
and attenuated vaccines, and culture dishes and devices used to
transfer, inoculate and mix cultures.
Handling of Biohazardous Waste
• Infectious waste, except for sharps, shall be contained in
disposable plastic bags or containers that are tearresistant, leak-proof, and secured to prevent leakage or
expulsion of solid or liquid waste during storage,
handling or transport.
• Department of Transportation (DOT) regulates shipping
of biohazardous waste. DOT requires that all
biohazardous waste containers have their inner bag tied
at the top in a single knot and the lid securely closed
prior to transport. ANY facility not complying with these
requirements is subject to heavy fines by DOT.
PROPER HANDLING OF
BIOHAZARDOUS WASTE
1. Only Biohazardous
Waste should be placed
in these containers items contaminated with
pourable/dripable or
dried, crusted blood or
body fluids, sharps (in
sharps containers), etc.
2. Waste must be placed
in a red bag in the tub to
comply with DOT regs.
Gather bag together
keeping the air in bag to a
minimum. Do not push
down on the bag or
puncture it to remove air.
PROPER HANDLING OF
BIOHAZARDOUS WASTE
3. Twist bag into single
braid.
4. Use the braid to tie
single knot.
“Bunny Ear” Ties do not
meet the DOT
requirements and could
result in a fine.
PROPER HANDLING OF
BIOHAZARDOUS WASTE
5. Tighten knot by placing
one hand above the knot
and pulling on the top of
the braid while push down
on the knot. Carefully tuck
the knot and bag into the
container.
6. Place lid on container
and snap it into place.
Container should be placed
at the designated pickup
location.
Bag Tying
The above pictures are examples of inappropriately tied
bags. Bags can not be left open, tied into dog-ears, or
taped/twist-tied closed. The only way to secure bags
that is acceptable to DOT is tying the bag at the top in
a single knot.
Inappropriately Packaged Waste
• This waste was
packaged
inappropriately. Once
the bag is tied, the lid
must be placed
securely on the
container.
Preparation for Transport
Prior to transport off campus, all
infectious waste shall be placed
in rigid or semi-rigid, leak-proof
containers such as disposable
or reusable pails, cartons,
boxes, drums or portable bins.
These containers may come in
different shapes and sizes, but
all must meet DOT criteria to be
used for biohazardous waste
transport. The 28-gallon
biohazardous waste containers
have a 50 pound weight limit.
Animal caresses must be
placed in the larger (taller) red
biohazardous waste containers
as the contents have a
tendency to expand under
certain conditions.
Biohazardous Waste Containers
Biohazardous waste containers shall be clearly
marked with the universal biohazard symbol
prominently displayed or labeled “biohazardous
waste” and sealed.
Inappropriate Packaging of
Containers
These two plastic bottles filled with used syringes were found in one of the
biohazardous waste areas. It is unlawful in the city of Omaha to dispose of
needles and syringes in such a manner; disposing of these items as they were
found on the dock is in violation of DOT regulations on the UNMC/Nebraska
Medical Center campus. Any containers such as these must be placed in an
approved large sharps container and then placed in the designated
biohazardous waste area for pick up.
Inappropriate Packaging of
Containers
This container was refused by our biohazardous waste vendor because the
container did not meet DOT transport regulations. Taping the top of the
container allows for sharps or blood and bloody fluids to leak around the weave
of the tape, if the container should tip over. Large biohazardous waste and
chemo waste containers such as these must be sealed with a tightly fitting lid
prior to transport.
Transporting Biohazardous
Waste
• Biohazardous waste
must be transported
in separate trailers or
carts designed for
biohazardous waste.
Biohazardous Waste Treatment
• In the state of Nebraska, autoclaving is
considered an appropriate means of rendering
waste “Non- All red bag biohazardous waste
must be rendered “non-infectious” using a
method approved by the state. infectious”.
• Biohazardous waste shipped off campus for
treatment must be properly packaged and
transported to an approved treatment facility. All
waste collected by our waste vendor is taken to
their processing plant, where it is autoclaved
and then dumped in the landfill with regular
waste.
Proper Segregation of Recyclable
Waste
The Red, White and Blue
Campaign
The Biohazardous Waste
Committee has created
an educational program
focusing on the three
largest waste streams
generated on The
Nebraska Medical
Center/UNMC campus
called the Red, White and
Blue Campaign:
Red = biohazardous
waste
White = general waste
Blue = recyclable waste
Recyclable Waste Issues
• These are pictures of
inappropriate waste found in
the recyclable waste on The
Nebraska Medical
Center/UNMC campus (each
picture is about one month’s
worth of waste)
Waste identified included surgical
items such as booties, masks,
gloves and hair bonnets
Laboratory supplies such as pipettes,
rapid test kits and their wrappers and
specimen containers were found
Biohazardous
waste, including
a syringe with
blood in it and a
bag of old
dressings
saturated with
blood were
identified
Other
equipment and
used linen
were found
Numerous patient pill bottles and
patient IV medications were found
Unused medical supplies and
nearly full boxes of medical
supplies were identified
NONE of the previously identified
waste is recyclable waste!
• Recyclable waste includes:
– Mixed paper
– Cardboard
– Aluminum cans
– Aerosol cans
– Surplus equipment
– Printer cartridges
– Scrap metal
Recyclable Waste
• Blue waste containers and the large green waste
bins are used for MIXED PAPER only!
– Cardboard is taken to special collection areas
by Environmental Services staff
– Aluminum cans are placed in special collection
receptacles (call the Recycling Center for these
X9-2163)
– Aerosol cans must go directly to the Recycling
Center
– Surplus equipment – call for pick-up X9-5899
– Printer cartridges – questions or pick-up call X95895
– Scrap metal – is taken to special collection
areas by appropriate staff
Red, White and Blue Campaign
For additional information on this program,
please contact:
Jan Keuchel, Chair, Biohazardous Waste
Committee:
559-3980
Lee Sholtz, Co-Chair, Biohazardous Waste
Committee: 559-2154
PROPER SEGREGATION OF WASTE
CREATES A HEALTHIER PLANET FOR
ALL OF US!