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Is your staff wise in waste management?

Is your staff wise in waste management?

All laboratorians must learn their labs' protocols for hazardous waste disposal, including emergency plans and comprehensive procedures for storage, packing, and hauling.

As anyone who has worked in a clinical laboratory for a long time knows, the amount of hazardous material waste that we generate is growing constantly. Chemical analyses, tissue fixation, and staining procedures each produce their share of chemical wastes. An inevitable byproduct of microbiologic testing is infectious waste. When we introduced the concept of universal precautions, we began to treat nearly all clinical wastes as infectious. The increasing use of disposables has exacerbated the issue of waste management.

While the total amount of waste is increasing, our greatest concern is for the portion that is hazardous. We must identify any refuse that could injure an employee or damage the environment--and learn to handle it properly. At the Cleveland Clinic Foundation, about 80 pounds of hazardous chemical waste are generated per 1,000 square feet of laboratory space each year--and the lab occupies well over 100,000 square feet. Within the same space, we generate about 1 ton of infectious waste and about 10 tons of general refuse annually.

As managers, we must insure the correct disposition of all laboratory wastes. Some materials, such as spent solvents and photographic developers, can be reclaimed. Chemical treatment of selected wastes may reduce their hazard level. Managers who understand local sanitary sewerage codes may direct employees to flush a variety of solutions down the drain. On-site incineration may be acceptable for other types of waste. In all but the smallest laboratories, the logistics of disposing of certain materials requires signing a contract with a vendor of waste management services.

Employees need to know the disposal strategy that management has chosen for each category of waste. They should be able to select the right containment system, understand how to label or otherwise identify the packaging, and know where it should be placed for safe disposal. The potential for spills, fires, floods, and other emergencies mandates contingency planning.

Such issues are best addressed in a formal training program. We recommend that waste handling be addressed at the time of new-employee orientation, whenever waste-generation realities or disposal protocols change, and annually thereafter.

* Identifying hazardous wastes. Chemical wastes may be identified by their characteristics. A corrosive is a substance that can cause visible destruction of human tissue at the site of contact: strong acids (pH<2.1) and highly alkaline liquids (pH>12.5). Ignitable liquids include those that have a low flashpoint or are strong oxidizers. Few clinical laboratory wastes are truly reactive--that is, capable of explosive detonation or able to emit dangerous vapors when mixed with water. The term toxic refers to any substances that can cause serious biologic effects when small amounts are inhaled, ingested, or absorbed. Regulatory definitions are provided in Title 40 of the Code of Federal Regulations, Part 261.

Infectious wastes include discarded microbiologic cultures; human blood and body fluids, as well as materials contaminated with such fluids; and human tissues. An operational definition for medical wastes includes discarded sharps and infectious wastes. (New York, New Jersey, Connecticut, Rhode Island, and Puerto Rico are regulated under the Medical Waste Tracking Act of 1988.) Although Federal regulations do not establish which materials must be handled as medical wastes in most parts of the country, some state and local regulations spell this out more explicitly. Consult all applicable codes before establishing your laboratory's medical waste policy.

* Packaging and storage. Waste solvents, such as xylenes and alcohols, often assume the greatest share of a laboratory's hazardous chemical wastes. Such solvents should be stored with the same fire protection considerations as are afforded to their reagent sources. Details are available in the Flammable and Combustible Liquids Code, National Fire Protection Association (NFPA) #30. The storage problem may be more severe for hazardous wastes if they are allowed to accumulate before transfer and disposal.

There are two basic methods for preparing hazardous chemical wastes for transport. In the first, wastes are poured into individual containers labeled with the name and concentration of the chemical and the date. Labeled containers are packed in steel drums, each of which must house compatible chemicals. The bottles must be surrounded by enough absorbent material to contain the contents even if all the primary containers were to fail. The drum must be properly labeled concerning its contents.

Outside vendors tend to prefer to do the packing of barrels they will transport. Because such materials can be stored on site no longer than 120 days, the packing must be done at least three times per year.

The second method involves pouring miscible and compatible chemicals directly into a large container, such as a steel drum. Discarded waste xylenes, labeled as mixed hydrocarbon solvents, may be handled in this way. Be sure to consult with your waste management vendor before initiating this practice.

Protective attire should match the level of containment to the level of hazard present. To prevent drenching from substantial amounts of waste solvent, the use of solvent-resistant gloves, eye protection, apron, and fume mask is strongly recommended. With either method, shipping manifests must be initiated before the materials are transported for disposal.

Infectious wastes that do not contain sharps should be double-packaged in rigid, leak-resistant containers. This is best accomplished by lining a waxed corrugated cardboard box with an appropriate plastic bag. Red color and the universal biological hazard (UBH) symbol mark the contents as infectious. Single-use containers are safer because they eliminate the problem of decontaminating between uses. The details of the packaging will depend upon the disposal method.

* Toxicity hazards. Some chemicals are short-term toxins; that is, they are irritants or asphyxiants or have acute metabolic effects. Other chemicals require containment because the effects they cause can accumulate over extended periods of time. These include tumor-causing agents, teratogens, and substances that can induce adverse reproductive effects. Every chemical that has been identified as a carcinogen by the National Toxicology Program or by the International Agency for Research on Cancer must be treated with caution.

* What is a carcinogen? The Occupational Safety and Health Administration refers to carcinogens of Class I and Class II potential (see Title 29, Code of Federal Regulations, Part 1990, Section 1990.112). The first term describes a chemical that has been shown to cause malignant tumors in humans or clearly in animal systems. Class II compounds are those for which experimental evidence is only suggestive.

The regulatory burden is great for employers who have Class I potential carcinogens in the workplace. Class I compounds are equivalent in practice to those that have been identified as carcinogenic by the National Toxicology Program (NTP) or by the International Agency for Research on Cancer (IARC). The most recent NTP list is available from the National Technical Information Service, 5285 Port Royal Road, Springfield, VA 22161. The telephone number is (703) 487-4650. Ask for the Fifth Annual Report on Carcinogens, Publication No. 89-23194.

The IARC publishes its data in monograph form. The most recent summary is IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Supplement 7. It is available from WHO Publications Center USA, 49 Sheridan Ave., Albany, NY 12210. The telephone number is (518) 436-9686.

Waste containers that include carcinogenic agents should be properly identified regarding the nature of the hazard. In addition, the name of the chemical, its concentration, and the date of packaging should be written on the label. No special format has been mandated for listing this information.

All considerations discussed above are integral parts of a proper chemical hygiene plan (29CFR 1910.1450).(1) All clinical laboratory employees should have a thorough working knowledge of the hazards of the chemicals with which they come into contact. Part of their awareness involves an understanding of the disposal method defined by management for each waste chemical. Consistency in proper waste disposal is key to a successful program.

* Sharps. The actual degree of risk that is presented to a community by its medical wastes is debatable. A lack of epidemiologic data has led the Environmental Protection Agency to state that containment of medical waste hazards must be based upon exposure potential.(2) This means that containment is primarily an occupational problem rather than an environmental one. Individuals who must handle waste containers are at greatest risk. Discarded needles, scalpels, lancets, broken glass, and rigid plastic account for nearly all occupational injuries among medical waste handlers.(3)

Even one misplaced item can cause serious injury. All sharps to be discarded must be placed in rigid puncture-resistant containers. The outside of the package should be red, display the UBH symbol, and clearly display the word SHARPS. Packages containing sharp hazards must be distinguished from medical waste packages that do not. It is not appropriate to insert a small receptacle of sharps within a larger box of discarded specimens or other infectious wastes.

* Importance of segregation. In the clinical laboratory, all waste generation begins at the bench. The technologist has the first, and perhaps only, opportunity to direct waste toward its appropriate disposition. Training programs should focus employees' attention upon proper waste segregation at the point of generation. The laboratory manager can deliver no more effective message than this for achieving a successful waste disposal plan.

Waste segregation can save money. Proper disposal of hazardous waste is far more expensive than that of general refuse. Federal regulations do not factor a substance's concentration into the definition of hazardous waste. The mixing of a small amount of a hazardous substance with a small quantity of an innocuous waste produces a large quantity of hazardous waste.

The more one can limit the amount of materials that must be handled with special care, the less expensive the entire waste disposal program will be to the laboratory. It may be convenient to have several containers in one's workspace: one for solvents, one for fixatives, another for tissues, and still another for sharps. In any case, multiple receptacles are necessary to control the hazards that these materials represent.

* Minimizing waste. As generally used, the expression hazardous waste minimization is taken to involve chemical wastes only. There is no reason the term should not be extended to include medical wastes as well, since it implies a reduction in both hazardous wastes and waste hazards. The twin goals are to reduce the total volume and quantity of hazardous wastes and lower the level to which those wastes are ignitable, reactive, corrosive, toxic, and infective.

Two approaches can achieve these goals: source reduction and recycling. Both involve restricting the amount of hazardous waste at the point of generation. Among the routes are insuring maximum efficiency of production areas, redesigning processes to use a lower volume of reagents, substituting less toxic materials wherever possible, and practicing effective waste segregation.

The recovery and reuse of the limited wastes that are then generated will also ease the impact of laboratory activity on the environment. This measure may involve on-site practices, such as distillation of solvents. More often it requires contracting with a vendor of waste service. The contractor will insure the material's reuse rather than directing it to long-term storage at a remote facility, such as a hazardous waste landfill.

Many waste management contractors will provide services beyond the removal of hazardous wastes. Some will sort and package wastes for transport. Some offer help in recycling and in developing a waste minimization program. When choosing a vendor, look for a firm that will assist you in meeting your Federal and state reporting requirements.

Employee incentive plans are particularly effective elements in hazardous waste minimization programs. The laboratory manager should solicit suggestions from the technologists who handle the materials every day. Encourage ideas that will lessen the expense of waste handling. Creative employees deserve to be recognized for contributions they have made that will help the laboratory reduce costs and meet its hazardous waste minimization goals.

* Contingency planning. Packaged wastes can be spilled. The laboratory must be prepared to control unexpected releases. Management should appoint an emergency coordinator with sufficient expertise to comprehend the level of hazard likely to have to be contained.(4) Because this individual may not be the first responder in the event of an accident, all employees who work in any area where hazardous wastes are packaged or stored should be equally prepared to initiate containment of a spill.

For simple spills, a general training session and the posting of emergency information may suffice. If large quantities of hazardous materials are stored or if toxic chemicals are contained in the lab, more detailed training of employees is indicated. Ignitable chemicals mandate preparation for fire control. Training in the use of fire extinguishing devices and fire exit procedures must be provided.

Appropriate materials for cleaning spills should be on hand. Commercially prepared cleanup kits are available. The items listed in Figure I should be handy and their storage location known to everyone in the work area. At least once a year, the supplies should be inspected and tested for functional integrity.

* Training. Competent handling of laboratory waste requires technical knowledge. Although compliance relies upon common sense and a general appreciation of the goal in view, there is no substitute for a formal training program covering the principles and procedures required. By dedicating time and effort to the subject, management demonstrates its belief in the importance of the issue.

Review your training program. Are teaching materials current? Are all employees who generate or handle wastes included? Does the program discuss the use of personal protective equipment, the details of safe work practices, and first aid and emergency procedures? Is everyone familiar with the facility's use of labels, signs, and manifests (forms tracking hazardous waste disposal)?

Training in waste management can be combined with that of chemical hygiene plans, control of bloodborne disease, or the Federal Hazard Communication Standard. To prevent recurrence, review reports of any accidents with employees. Convey successes in the lab's waste minimization program at annual updates.

Management must provide appropriate and effective training to all personnel involved. Employees have the responsibility to comply with established policies and procedures. Staff members are also duty bound to bring to management's attention any recognized unsafe working conditions as well as any opportunities they observe for hazard reduction. As managers, our corresponding obligation is to listen to those concerns and to incorporate as many of them as possible into the waste management plan.

Figure I

Equipment for cleaning spills

Sand (to dike spills) Soda ash (to contain acids) Vermiculite (to absorb solvents) Non-sparking shovel Water-resistant shoe covers Heavy-duty rubber gloves Safety goggles Plastic bags Broom Dustpan Barrier ribbon Flashlight (1)Ramaley, S.A. Developing a laboratory chemical hygiene plan. MLO 22(12): 37-40, December 1990. (2)Slavik, N.S. Report on the Proceedings of the EPA Infectious Waste Management Meeting. Environmental Protection Agency, Washington, D.C., Nov. 12, 1987. (3)Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services. "The Public Health Implications of Medical Waste: A Report to Congress." Washington, D.C., September 1990. (4)Title 40, Code of Federal Regulations, Part 262, Section 262.34(d)(5).

PHOTO : Containers of various sizes and colors will meet regulatory requirements. What's most important is to mark and label them properly.

PHOTO : Above: Following guidelines for packaging and transporting medical waste. Below: Cleaning up a simple chemical spill.

Gerald A. Hoeltge, M.D. The author is chairman of the department of blood banking and transfusion medicine at the Cleveland Clinic Foundation.
COPYRIGHT 1991 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1991 Gale, Cengage Learning. All rights reserved.

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Author:Hoeltge, Gerald A.
Publication:Medical Laboratory Observer
Date:Apr 1, 1991
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