Disposal of Biomedical Disposal of Biomedical WastesWastes

Biomedical Waste Presents a Serious Health Biomedical Waste Presents a Serious Health ProblemProblem

Risks Include:Risks Include: Outright Injury to WorkersOutright Injury to Workers Exposure to Infectious AgentsExposure to Infectious Agents

Psychological TraumaPsychological TraumaRegulatory ActionsRegulatory ActionsLegal ActionsLegal ActionsEnvironmental IssuesEnvironmental Issues

The Risks involve:The Risks involve:Medical StaffMedical StaffHealthcare WorkersHealthcare WorkersMaintenance and Housekeeping StaffMaintenance and Housekeeping StaffDisposal Company StaffDisposal Company StaffLandfill EmployeesLandfill EmployeesInnocentInnocent and Unaware Public (Kids)and Unaware Public (Kids)

Some Facts from CDCSome Facts from CDC SharpsSharps

385,000 needlesticks and other sharps-related 385,000 needlesticks and other sharps-related injuries injuries

are sustained by hospital-based healthcare personnel; are sustained by hospital-based healthcare personnel; an average of 1,000 sharps injuries per dayan average of 1,000 sharps injuries per day

Direct costs associated with the initial and follow-up Direct costs associated with the initial and follow-up treatment of exposed healthcare personnel, which are treatment of exposed healthcare personnel, which are estimated to range from $500 to $3,000 depending on estimated to range from $500 to $3,000 depending on

the the treatment provided treatment provided Biomedical WasteBiomedical Waste

Every year, the United States produces Every year, the United States produces approximately 3.2 million tons of medical waste, approximately 3.2 million tons of medical waste, which includes blood and human waste, used needles which includes blood and human waste, used needles and other "sharps," pathological and infectious and other "sharps," pathological and infectious wastes, "isolation" waste (i.e. waste that could wastes, "isolation" waste (i.e. waste that could spread highly communicable diseases) and some spread highly communicable diseases) and some cytotoxic waste (i.e. chemotherapy byproducts). cytotoxic waste (i.e. chemotherapy byproducts).

Some Facts from Okanogan CountySome Facts from Okanogan County

The Okanogan County Sanitary Landfill has been seeing 3 to 5 The Okanogan County Sanitary Landfill has been seeing 3 to 5 incidents of illegal Biomedical Waste Disposal per week. incidents of illegal Biomedical Waste Disposal per week.

The reports forwarded to Okanogan Public Health by the Landfill The reports forwarded to Okanogan Public Health by the Landfill have not been “gray area” violations, but clear and flagrant have not been “gray area” violations, but clear and flagrant violations.violations.

In addition to violation of local and state regulations on In addition to violation of local and state regulations on biomedical waste, there have clear violations of HIPAA biomedical waste, there have clear violations of HIPAA confidentiality and security regulations (photo documented)confidentiality and security regulations (photo documented)

4/8/2005: 4/8/2005: Unshredded medical records, bloody sponges, gauze, glovesUnshredded medical records, bloody sponges, gauze, gloves biohazard bag, bloody drapes sponges contained in black biohazard bag, bloody drapes sponges contained in black plastic bagplastic bagConsequence:Consequence: Entire 15,700 pound load was treated as biomedical waste Entire 15,700 pound load was treated as biomedical waste

4/1/2005: 4/1/2005: Biohazard bags in dumpster with regular garbage Bags with Biohazard bags in dumpster with regular garbage Bags with blood blood gauze, mouth swabs etc gauze, mouth swabs etc

3/31/2005: Bloody Plastic tubes, drapes and trays C-section materials3/31/2005: Bloody Plastic tubes, drapes and trays C-section materials

February 15February 15, , 2005: 2005: Okanogan County Public Health Mailed out Letters to Okanogan County Public Health Mailed out Letters to offending waste generatorsoffending waste generators

Continued improper disposal places not only the health of workers at risk Continued improper disposal places not only the health of workers at risk but also but also the continued operation of disposal companies and landfill.the continued operation of disposal companies and landfill.

Public Health, the county landfill and the disposal Public Health, the county landfill and the disposal companies are running out of options.companies are running out of options.

November 2006 : Okanogan County Adopted a Biomedical November 2006 : Okanogan County Adopted a Biomedical Waste Code with significant penalties and fees: Waste Code with significant penalties and fees:

11stst Offense: $ 125 + clean up fees Offense: $ 125 + clean up fees22ndnd Offense: $1,000 + clean up fees Offense: $1,000 + clean up fees33rdrd Offense: $4,000 + clean up fees Offense: $4,000 + clean up fees44thth Offense: $10,000 + loss of disposal privileges Offense: $10,000 + loss of disposal privileges

Local, State and Federal Local, State and Federal Regulations Require:Regulations Require:

Biomedical Waste must be Biomedical Waste must be Segregated from regular Segregated from regular Domestic Waste at the Site Domestic Waste at the Site of Origin or Generationof Origin or Generation

The Okanogan County Landfill The Okanogan County Landfill receives 3 to 5 cases per receives 3 to 5 cases per week of mixed domestic and week of mixed domestic and biomedical wastebiomedical waste

Local, State and Federal Regulations governing Waste Disposal Local, State and Federal Regulations governing Waste Disposal Companies require:Companies require:

Specialized containers and Handling procedures for Biomedical Specialized containers and Handling procedures for Biomedical WasteWaste

It is Illegal for Waste Disposal Companies to carry mixed or un-It is Illegal for Waste Disposal Companies to carry mixed or un-segregated Domestic Waste and Biomedical Wastesegregated Domestic Waste and Biomedical Waste

It is illegal to compress or compact Biomedical WasteIt is illegal to compress or compact Biomedical Waste

Disposal companies can be Disposal companies can be fined and/or lose their fined and/or lose their operating permits for operating permits for violations of these regulationsviolations of these regulations

Disposal Companies can refuse Disposal Companies can refuse to accept mixed wastesto accept mixed wastes

2) "Biomedical waste" means solid waste of the following types:Biomedical waste" means solid waste of the following types:

(a) "Animal (a) "Animal wastewaste," which includes ," which includes wastewaste animal carcasses, body parts, and bedding animal carcasses, body parts, and bedding of animals of animals that were known to have been deliberately infected or inoculated with human that were known to have been deliberately infected or inoculated with human pathogenic microorganisms during research.pathogenic microorganisms during research.

(b) "Liquid human body fluids" means (b) "Liquid human body fluids" means wastewaste that includes that includes wastewaste liquid emanating or derived liquid emanating or derived from humans including but not limited to human blood and blood products, serum and plasma, from humans including but not limited to human blood and blood products, serum and plasma, sputum, drainage secretions, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, sputum, drainage secretions, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid and amniotic fluid that exceeds fifty milliliters per container, storage vessel, or pericardial fluid and amniotic fluid that exceeds fifty milliliters per container, storage vessel, or plastic bag and cannot be and has not been directly discarded into a sanitary sewage system.plastic bag and cannot be and has not been directly discarded into a sanitary sewage system.

(c) "Cultures and stocks" means (c) "Cultures and stocks" means wastewaste that includes that includes wastewaste cultures and stocks of cultures and stocks of microbiological agents infectious to humans, human serums and discarded live and attenuated microbiological agents infectious to humans, human serums and discarded live and attenuated vaccines infectious to humans, human blood specimens, and laboratory wastes that are vaccines infectious to humans, human blood specimens, and laboratory wastes that are contaminated with these agents or specimens.contaminated with these agents or specimens.

(d) "Biosafety level 4 disease (d) "Biosafety level 4 disease wastewaste," which includes wastes contaminated with blood, ," which includes wastes contaminated with blood, excretions, exudates, or secretions from humans or animals who are isolated to protect others excretions, exudates, or secretions from humans or animals who are isolated to protect others from highly communicable infectious diseases that are identified as viruses assigned to Biosafety from highly communicable infectious diseases that are identified as viruses assigned to Biosafety Level 4 by the Centers for Disease Control, National Institute of Health, Biosafety Level 4 by the Centers for Disease Control, National Institute of Health, Biosafety

(e) "(e) "Pathological waste," which includes waste human source biopsy materials, tissues, Pathological waste," which includes waste human source biopsy materials, tissues, and anatomical parts that emanate from surgery, obstetrical procedures, autopsy, and and anatomical parts that emanate from surgery, obstetrical procedures, autopsy, and laboratory procedures. "Pathological waste" does not include teeth or formaldehyde or laboratory procedures. "Pathological waste" does not include teeth or formaldehyde or other preservative agents, human corpses, remains, and anatomical parts that are other preservative agents, human corpses, remains, and anatomical parts that are intended for interment or cremation.intended for interment or cremation.

Regulatory Definitions of Biomedical WastesRegulatory Definitions of Biomedical Wastes

Sharps WasteSharps Waste

"Sharps "Sharps wastewaste," which includes ," which includes wastewaste hypodermic needles, hypodermic needles, syringes, IV tubing with needles attached, scalpel blades, and syringes, IV tubing with needles attached, scalpel blades, and lancets that have been used in animal or human patient care or lancets that have been used in animal or human patient care or treatment in medical research.treatment in medical research.

E. Sharps shall be contained for storage, transportation, E. Sharps shall be contained for storage, transportation, treatment, and disposal in leak-proof, rigid, puncture-treatment, and disposal in leak-proof, rigid, puncture-resistant containers which are taped closed or tightly resistant containers which are taped closed or tightly lidded to preclude content loss.lidded to preclude content loss.

8.62.040Infectious waste segregation requirements for generators.

Under no circumstances shall infectious waste generated from Under no circumstances shall infectious waste generated from within Okanogan County be mixed or placed with other solid within Okanogan County be mixed or placed with other solid waste for storage or transfer when said solid waste is destined waste for storage or transfer when said solid waste is destined for treatment and/or disposal in a facility requiring segregation for treatment and/or disposal in a facility requiring segregation of infectious waste.of infectious waste.

A.A. Infectious waste generated or received in Okanogan County Infectious waste generated or received in Okanogan County shall not be mixed or placed with other solid waste for storage or shall not be mixed or placed with other solid waste for storage or transfer when such solid waste is destined for treatment and/or transfer when such solid waste is destined for treatment and/or disposal in a facility requiring segregation of infectious waste.disposal in a facility requiring segregation of infectious waste.

B. B. Infectious waste shall be segregated from other solid Infectious waste shall be segregated from other solid waste at the point of origin in the generating facility and waste at the point of origin in the generating facility and managed by persons trained in the safe handling of managed by persons trained in the safe handling of infectious waste.infectious waste.

Okanogan County CodeOkanogan County Code

Basic RulesBasic Rules

1. Biohazard or Biomedical Waste Biohazard or Biomedical Waste must be separatedmust be separated from from “normal“normal

domestic waste”domestic waste”

2. Separation of waste is the responsibility of the waste 2. Separation of waste is the responsibility of the waste generator generator at at thethe point of origin.point of origin.

3. Waste in 3. Waste in Biohazard or Biohazard or Orange BagsOrange Bags is considered is considered Infectious Infectious by default.by default.

4. 4. The disposal company or transporter can refuse to pick up The disposal company or transporter can refuse to pick up mixed mixed waste.waste. Regulations obligate him to refuse. By county, state Regulations obligate him to refuse. By county, state regulations regulations Biomedical waste cannot be compacted and there are Biomedical waste cannot be compacted and there are relatively strict relatively strict regulations regarding the transport of biomedical waste.regulations regarding the transport of biomedical waste.

5.Personnel handling biomedical waste are required to have 5.Personnel handling biomedical waste are required to have appropriate protection.appropriate protection.

Biomedical WasteBiomedical Waste

Consequences of Noncompliance: Consequences of Noncompliance:

Fines to Health Care Provider or AgencyFines to Health Care Provider or Agency

Regulatory Actions: Regulatory Actions: Loss of Disposal RightsLoss of Disposal Rights

Loss of LicensesLoss of Licenses

Legal Claims or Lawsuits by injured partiesLegal Claims or Lawsuits by injured parties

Basic PrecautionsBasic Precautions

Don’t Mix Orange or Biohazard Marked Bags or Materials Don’t Mix Orange or Biohazard Marked Bags or Materials with with normal wastenormal waste

Don’t put normal waste or papers in Biohazard BagsDon’t put normal waste or papers in Biohazard Bags

When in Doubt check with your SupervisorWhen in Doubt check with your Supervisor

If there are questions or concerns on the shipment of If there are questions or concerns on the shipment of Biomedical Biomedical Materials Materials

Sharps represent the most significant threat: Use proper Sharps represent the most significant threat: Use proper disposaldisposal

Please contact: 1) Okanogan County LandfillPlease contact: 1) Okanogan County Landfill

2) The Waste Disposal Company2) The Waste Disposal Company

3) Okanogan County Public Health3) Okanogan County Public Health

Resources for Biomedical Waste IssuesResources for Biomedical Waste Issues

Contact InformationContact Information

Okanogan County LandfillOkanogan County LandfillLANDFILL AND TRANSFER STATIONSLANDFILL AND TRANSFER STATIONS Central Landfill – Okanogan:  422-2602Central Landfill – Okanogan:  422-2602    Open Tuesday- Saturday 9am-5pm  Open Tuesday- Saturday 9am-5pm 

Bridgeport Bar Transfer Station: 686-4242Bridgeport Bar Transfer Station: 686-4242

Twisp Transfer Station:  997-2025 Twisp Transfer Station:  997-2025 Open Tues, Thurs; 12-4pm, Sat. 9am-4pm  Open Tues, Thurs; 12-4pm, Sat. 9am-4pm 

    Ellisforde Transfer Station  476-3910 Ellisforde Transfer Station  476-3910

Okanogan County Public HealthOkanogan County Public Health1234 South Second Avenue in Okanogan, Washington.1234 South Second Avenue in Okanogan, Washington.Phone: 509-422-7140 Phone: 509-422-7140 Fax: 509-422-7142Fax: 509-422-7142Mailing Address:  PO Box 231, Okanogan, WA 98840Mailing Address:  PO Box 231, Okanogan, WA 98840

Biomedical Waste Disposal ContractorBiomedical Waste Disposal ContractorStericycleStericycleErik JacobsonErik Jacobson800-633-9278800-633-9278ejacobson@stericycle.comejacobson@stericycle.com

Sharps Disposal for Private CitizensSharps Disposal for Private Citizens

Okanogan County Public Works Maintains Drop-Off Stations at the following locationsOkanogan County Public Works Maintains Drop-Off Stations at the following locations

Okanogan County Central LandfillOkanogan County Central LandfillBridgeport Bar Transfer StationBridgeport Bar Transfer StationEllisforde Transfer StationEllisforde Transfer StationTwisp Transfer StationTwisp Transfer Station

Omak: Omak: Ulrich DrugUlrich DrugOkanogan: Okanogan: J&S DrugJ&S DrugTonasket: Tonasket: Roy’s PharmacyRoy’s PharmacyBrewster: Brewster: Brewster DrugBrewster Drug

Regulations and Educational ResourcesRegulations and Educational Resources

Okanogan County Biomedical Waste CodeOkanogan County Biomedical Waste Code

Washington State RegulationsWashington State Regulations

WAC 296-62-08001 Bloodborne Pathogens

WAC 173-300-020

Washington State Mercury Chemical Action Plan (Almalagm)

Centers for Disease ControlCenters for Disease Control

General Laboratory Safety

Workbook for a Sharps Injury Prevention Program

Biosafety in Biomedical LaboratoriesBiosafety in Biomedical Laboratories

World Health OrganizationWorld Health Organization

Wastes from Health-care activitiesWastes from Health-care activities

The Nightingale InstituteThe Nightingale Institute

Recommendations for Improving Medical Waste Management  Recommendations for Improving Medical Waste Management  

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