Written by Rose Cartwright,
Correct handling of medical waste is everyone’s job, with the ultimate goal of protecting everyone, from medical, administrative, and custodial staff to patients, visitors, and the community at large. Improper waste management in a medical organization is a massive risk with far-reaching implications for both the facility and those who operate within it. Consider something as simple as an incorrectly stored sharp: If a staff member incurs a needlestick injury as a result of negligence, this creates another patient with another complex set of needs. It also triggers an administrative process involving internal reporting, the involvement of workers’ compensation, and, if the injury is serious enough, possible legal action.
The first step in avoiding this unpleasant chain of events is hiring a qualified medical waste disposal company. A credible waste disposal company will review your facility’s waste output and ensure that your containers and bins are appropriately suited for it, eliminating the chances of misplaced sharps or overflowing containers.
Understanding Medical Waste Classifications
Regulated medical waste typically falls into one of three categories:
Healthcare waste:
- Pathological waste
- Blood-contaminated items, such as bandages
- Laboratory and treatment materials, such as body tissue
Sharps:
- Needles
- Lancets
- Scalpels
- Both broken and intact contaminated glass, such as drug vials
Pharmaceuticals:
- Expired and unused medication
- Disinfectants
- Lab reagents
No matter what the waste item is, the moment it’s generated, it must be classified correctly and enter the requisite waste stream for its category. This includes general nonhazardous waste as well, which must have its own dedicated waste stream so as not to create confusion or add additional weight to regulated waste bins. For maximum efficiency and safety, this means the correct containers must be placed in the correct locations, with labels and easy-to-follow instructions for disposal.
Understanding the Regulations
It’s one thing to comply with federal, state, and local regulations in principle; it’s another to demonstrate that compliance in a legal setting. In order to meet legal compliance requirements, a facility must obtain and keep track of training records, inspection documentation, incident reports, vendor information, and corrective action paperwork. These documents must also be completed to code and signed off on by the necessary parties. Compliance officers rely on the written record in addition to the practical examination of the facility, and incomplete paperwork can delay rulings or create mistrust even if everything is above board.
Don’t be fooled by generic national waste management checklists, they may seem helpful, but healthcare settings call for a more robust set of standards than a general checklist can provide. OSHA’s Bloodborne Pathogens standard must be consulted in cases of exposure to infectious materials, post-exposure protocols, and handling sharps. If any of the medical waste produced is classified as hazardous, then EPA requirements also come into play. Transportation is also regulated, and although it may vary by jurisdiction, it must often comply with DOT requirements.
Segregation and Containment
Medical organizations are hectic and busy by nature, but this is no excuse for ignoring or rushing through waste segregation. There is no reason for a waste item to remain in a work area outside of its container for any reasonable length of time, and any instance of this immediately puts the facility at risk. Every staff member should be properly trained on the four categories of waste they will encounter at the facility: healthcare waste, sharps, pharmaceuticals, and general waste, as well as how to handle and segregate waste the moment it’s produced.
Set the staff up for success by placing sharps containers where they’re needed, with a visible fill line and instructions, as well as regular monitoring of both rigid containers and bags for every type of waste. Safety officers must also watch out for unlabeled receptacles, containers moved to undesignated spots for convenience, loose items beside bins, or patterns of staff choosing the nearest container instead of the correct one.
Safe Handling and Storage
Restrictive signage expressly forbidding anyone but authorized staff from entering waste-storage areas is the first line of defense against hazardous exposure following disposal. The second is appropriate personal protective equipment (PPE) for the staff that is permitted to collect, transport, store, or clean around medical waste receptacles. Policy should ensure the layout allows staff to clean between waste-area surfaces and prevents cross-contamination between different waste streams. Supervisors must verify these details during routine inspections. Spill kits, emergency contacts, and instructions should be easily accessible to staff at all times.
When a problem arises, there must be a clear chain of command in place, and staff members must understand at what point they are to stop work and escalate it to a supervisor or another employee. Finally, training should not only include this information, but also provide an explanation for the why; otherwise, the process may feel arbitrary and lead to less retention and application.
Treatment and Disposal
Compliance doesn’t end when waste leaves the premises, and since waste treatment is outsourced, facilities must verify where the waste is going and what type of treatment it will undergo or face further penalties. Incineration is appropriate for certain materials, but it also produces emissions and requires specific permits. Autoclaving uses steam sterilization and therefore reduces microbial contamination but is not suitable for pathological or chemotherapy waste, nor can it be used on anything that can melt and emit fumes. Chemical treatment and microwave systems are also useful in specific settings, but all these methods must be compliant and produce clear documentation trails in order to be approved. Medical organizations should work with service providers that employ compliant processes, hold the necessary permits, and have contingency plans in place.
Working With a Medical Waste Disposal Company
Selecting a suitable medical waste disposal provider involves verifying that every step of the process will be documented, including waste collection, any required treatment, and final disposal. A reputable provider will take the time to explain its permits, treatments, transportation, staff training, documentation practices, and plans for service disruptions, and won’t balk at questions posed by the facility during the initial consultation.
The final decision on pickup frequency and waste container type should be a collaboration between the provider and the facility, with changes in waste volume, emergencies, or operational changes being part of an ongoing dialogue. Healthcare organizations should also look into the waste company’s references and performance data to see how they perform, since a contract will not reveal this information. If accountability seems vague, transportation is unreliable, or documentation is incomplete, it is best to continue looking for another waste removal company, even if their prices are competitive. Low prices are not a guarantee of good service, and when a company’s prices seem “too good to be true,” they often are.
Staff Training
A facility’s waste disposal system touches every part of an organization and therefore must be part of training for every type of staff member. Because waste management is so crucial to the environmental health of the building, every department must work together to ensure compliance and avoid small mistakes that can snowball into habit. Team members should feel comfortable reporting when waste isn’t handled appropriately, a container is damaged, or a pickup is missed, not feel guilty or uncomfortable. To facilitate this, team leaders should foster a strong safety culture by making reporting easy and low pressure. It’s imperative that supervisors respond with understanding rather than from a place of blame, investigate what conditions led to the event, and communicate the next steps to the appropriate parties with clarity. Reporting that leads to practical changes that can be seen every day results in staff that is more likely to participate in prevention.
Training new hires begins with online modules that cover every facet of the waste disposal process and the duties specific to their position, but competency checks are what keep whole teams sharp and able to apply these concepts to real-world scenarios.
Documentation and Inspections
The best way to prepare for an outside audit is to perform internal ones routinely, with a focus on the design of the overall on-site waste handling system. The workload, equipment, and communication systems should also be evaluated, and observable issues should lead to practical, ongoing improvements. These improvements should be monitored for efficacy and updated or implemented in other locations based on the data. Key points of focus should be examining work areas, storage of waste, staff training, vendor documentation, and the consequences of earlier findings.
By tracking waste volumes by type, pickup frequency, container use, incidents, and exceptions, a facility can catch a compliance issue before an inspector does. For example, if regulated waste volume suddenly increases, it may mean medical waste was mixed in at some point, or if containers are consistently overflowing, pickups are likely scheduled at the wrong frequency. Routinely reviewing these types of patterns helps management take concrete action in advance of an inspection that could result in costly fines and reputational loss. Documenting whether any corrective actions changed the process for the better is also helpful when applying for funding to make further improvements down the line.
Balancing Cost and Safety
Cost and safety often go hand in hand, but both can be compromised when an organization takes shortcuts in an attempt to save money. Consider a facility that puts an overflow of medical waste into the general waste stream. Not only are they compromising the safety of countless people down the line, but they’re likely increasing their general waste cost, poisoning their own data for future audits, and risking fines that would far exceed the cost of a proper disposal service. Not to mention potential lawsuits from needlestick injuries.
Rather than guessing at where to cut corners, medical organizations should instead record waste volumes, service types and frequencies, and incident reports so they can get a clear picture of where financial losses are occurring. Improper waste handling is more often a cause than it is a solution, and the documentation will likely reveal that fact.
Proper container selection, vendors that consolidate services, properly segregated waste, and contracts with providers that reflect actual patterns of waste generation are genuine improvements that may end up paying for themselves. It may be tempting to invest in the latest technology for training and maintenance, but management must assess whether the investment is likely to produce a return or is just serving to keep up the appearance of progress.
Small Steps Forward
Small tangible adjustments to behavior and equipment create greater lasting change than sweeping overhauls. Simplifying where waste receptacles are placed, removing improper containers, making the labels clear, conducting regular observations, and observing incident trends to inform retraining efforts all lead to gradual improvement over time. These improvements should all go hand in hand with relevant training for the appropriate staff, tailored to each individual’s position. Management should also continually reassess vendor relationships to ensure that their contracts are still followed and ongoing performance is up to par.
Waste volume increasing while storage and pickup schedules remain unchanged, and improper segregation of waste are larger issues that must be addressed before the situation goes on unnoticed for weeks, creating a genuine hazard. Sending regulated waste into general waste streams poses a risk to both human and environmental health, so keeping it separated is paramount.
A Complete System
Waste management is no less important than other operational functions and must be treated as such by medical organizations. Beginning with clear expectations will set the staff up for success and ensure every team member understands their role in waste-handling safety. When services expand, contract, or become modified in any way, procedures should be reviewed again to eliminate gaps in comprehension.
A successful waste management program connects infection prevention, environmental safeguards, and general facilities management to create a system that keeps people safe and quotas met.
Author Bio:
Rose Cartwright is an author and blogger whose work explores recycling, sustainability, and environmental science. When not writing, she can be found riding her horse, Chestnut, or facilitating creek cleanup initiatives in her hometown of Ithaca, New York.
Please also review AIHCP’s Managed Health Care Certification program and CE courses see if it meets your academic and professional goals. These programs are online and independent study and open to qualified professionals seeking a four year certification