Infectious waste in camp.

During the summer of 1988, a public outcry arose when medical waste -- syringes, blood vials, and other medical debris -- washed up on beaches along the Atlantic, Gulf and Great Lakes coasts. Since then, medical waste in general and infectious waste in particular have been the focus of public debate, government legislation, and municipality concern.

Most notably, the Occupational Safety and Health Administration passed in December 1991 new regulations concerning occupational exposure to blood-borne pathogens. These rules, which apply to all camps, specify that proper disposal of potentially infectious waste must be ensured.

As a result, camps are identifying the need to rework their procedures for handling waste from their health centers. Although the disposal of infectious waste may require some investigation of local regulations and available resources, the effort is critical. Incorrect disposal of infectious waste can be both a health and an environmental hazard.

Defining Infectious Waste

Camp health centers generate medical waste, a term used to describe refuse from a health-care facility. Medical waste includes band-aid wrappers, used tissues, syringes and medication cups. While most medical waste is noninfectious, some is. Infectious waste is "waste which contains pathogens with sufficient virulence and quantity so that exposure to the waste by a susceptible host could result in an infectious disease" (Sell, 1990). Infectious waste includes any of the following items that have not been decontaminated: laboratory waste, blood, regulated body fluids, and sharps (Feldman, 1989). Used syringes and finger lancets are commonly found infectious waste materials in a camp setting. While items such as dried blood on a band-aid are currently not classified as infectious waste, other items are considered potential reservoirs of infection and should be handled to minimize the risk of disease. Urine-contaminated items (e.g. from bed-wetting campers), vomitus, tampons and other human contact waste materials are examples found in the camp environment.

Handling Infectious Waste

There are two concerns specific to handling infectious waste. The first refers to handling such waste in the camp itself. As part of the camp's risk management plan, procedures about handling potential sources of infectious material should be written. The content of these procedures should be based on the universal precautions recommended by the Centers for Disease Control (CDC) and be specific to the camp's clientele.

In general, universal precautions require that disposable gloves are available -- and used -- both in the health center and in first aid kits. It means that staff are coached to place a barrier between themselves and a bleeding wound, that health centers have containers used specifically for disposal of sharps, and that infectious waste from the health center is separated from other health-care waste. In addition, education about the importance of and effective methods for hand washing should be developed and implemented.

Disposable towels and tissues or other materials contaminated with blood should be disposed of in a trash container lined with plastic. Tied plastic bags can then be put in the regular trash for disposal. Regulated waste (e.g. liquid or semi-liquid blood and items dripping with blood) should be placed in closable and labeled or color-coded containers and delivered to an appropriate disposal site.

In general, routine housekeeping procedures for cleaning and laundry are satisfactory for cleaning working surfaces and equipment exposed to potentially infectious spills (e.g. vomitus, urine, and feces). Commercially available cleaners compatible with most surfaces (detergents, disinfectant-detergents, or chemical germicides) can be used. For large spills involving blood or other human secretions or excretions, the American Academy of Pediatrics' Committee on Infectious Diseases recommends a freshly prepared solution of dilute (1:64) household bleach (V4 cup diluted in one gallon of water) or other chemical germicide be used as a disinfectant.

Beyond housekeeping procedures, camps must determine how infectious waste can safely be incorporated into the general waste stream. Regulation of infectious waste disposal may come from federal, state or local sources. Camp directors are urged to contact their local solid waste officer and/or the state's Department of Health to determine what regulations affect their camp.

Tracking of health care waste is currently not regulated by the Medical Waste Tracking Act, because most camps generate under 50 pounds of medical waste per month (Ballou, 1990). There are, however, things to consider when arranging for disposal, especially if using a landfill. For example, some camps use tin cans or rigid plastic containers for holding sharps. According to Juanita Heiser, Infectious Waste Control representative, Minnesota Department of Health (personal communication), a study was recently completed in the state of Washington which demonstrated that the common plastic 2-liter soda bottle was a better disposal container for sharps. It has the advantage of being able to withstand the compaction pressure that occurs at landfills. In addition to this tip, Sell (1990) offers the following comments for disposing of infectious waste at a landfill: a. Know if the landfill operator needs

advance notice before receiving a

shipment of infectious waste. b. Transport infectious waste

separately from other solid waste in

secured, leak-proof containers. c. Determine if infectious waste needs

to be left at a location different from

where other solid waste is left.

Landfill use is only one option for infectious waste disposal. Another is to arrange for disposal through the local health care community. Many hospitals are now providing free sharps containers, which they will dispose of when filled. Contact your local hospital's infection control officer for more information. Public health nurses and home health care businesses may also be able to help. In addition, the camp physician may agree to dispose of the waste. Finally, there are also companies who, for a fee, provide sharps containers which, when full, are mailed back to the company for disposal. Most use incineration as their disposal route.

The key to handling the disposal of infectious waste lies in knowing the resources available in your area. While locating these resources may take time, the effort is well spent. The volume of medical waste is certain to grow, regulation is certain to continue, and concern with safety in the disposal process is certain to remain. By managing infectious waste efficiently in the current camp environment, problems in the future can be minimized.

References

Ballou, K.L. (1990). How to comply with the medical waste tracking act of 1988. Connecticut Medicine, 54 (2), 91-91. Feldman, M.K. (1989). Infectious waste disposal: The rules just got tighter. Minnesota Medicine, 72 (9), 510-515. Sell, S.H. (1990). Disposal of infectious wastes in sanitary landfills. Journal of the Tennessee Medical Association, 83 (1), 24, 26.

For More Information

For information concerning the development of camp health plans, contact the Association of Camp Nurses at 8504 Thorsonveien, Bemidji, MN 56601; or call 218/586-2556. Additional information can be obtained through your state OSHA office.

OSHA's regulations concerning occupational exposure to blood-borne pathogens can be found in the Federal Register for Friday, December 6, 1991 (29 CFR Part 1910. 1030). For an overview of these regulations and their impact on camps, see the May 1992 issue of The CampLine, published by the American Camping Association and available through the ACA Standards Department, 5000 State Road 67 North, Martinsville, IN 46151-7902.