EM
planners:
As
part of any comprehensive plan during disease outbreak (endemic, epidemic,
pandemic) disease containment practices must be strictly adhered to.
Patient
identification, isolation, treatment, proper disposal of medical waste, and human remains of deceased handled with
some form of religious practice and customs which may not be safe or practical.
Current
focus has been on the Ebola pandemic affecting West Africa nations, World
Health Organization (WHO), Doctors without Borders, and other organizations
assistance in response to these outbreak in each regional nation involved.
The
following information is not a comprehensive plan of action, but only one
portion of an entire plan for addressing medical disease containment that must
be considered by emergency planners. A constant review, table-top
exercises, and other procedures to ensure plans are effective and up to date.
Medical
equipment and suppliers shall always have to be included in every aspect of
your planning process.
Your
local public health office\agency should provide additional guidance, and
policy.
Charles D. Sharp
Chief Executive Officer
Black Emergency Managers Association
1231 Good Hope Road S.E.
Washington, D.C. 20020
Office: 202-618-9097
bEMA
“Our lives are not our own. We are bound to
others, past and present, and by each crime and every kindness, we birth our
future.” ¯ David Mitchell, Cloud Atlas
Medical Waste Considerations for Waste
Handlers
MEDICAL WASTE CONSIDERATIONS
Overview
Why Should You Be Concerned About Medical Waste?
Hospitals, clinics, nursing homes, laboratories, doctors'
and veterinarians' offices, private households-and many other places-have to
dispose of materials that have been used in medical care or treatment. Some of
this material is infectious-that is, it has the potential to cause some kind of
infection and/or disease. Examples of medical wastes are used
"sharps"-hypodermic needles and syringes, IV needles, scalpel blades,
and glass items; items containing or soaked with blood or certain other body
fluids; human or animal organs or body parts; lab cultures that may contain
disease-causing agents; and things like gloves, bedding, dressings, sponges,
and other items that have been used in surgery, autopsy, or treatment of
patients with certain contagious diseases.
It is possible for medical waste to cause infection and/or
disease if it enters the body through broken skin or puncture wounds; if it
splashes into the eyes, nose, or mouth; if it is inhaled; or if it is
swallowed.
Medical waste may be dangerous for other reasons besides the
risk of disease-for example, sharps can cause cuts. Some of the material
disposed of by hospitals and other health care facilities may be hazardous for
other reasons. It may contain hazardous chemicals, or low-level radioactive
wastes. If the medical waste contains hazardous waste or radioactive waste, it
cannot go to solid waste landfills.
On the other hand, not all waste created at such facilities
is dangerous. Hospitals contain offices and cafeterias that create waste that
is not dangerous, and much of the waste generated by patient care poses no
threat at all to landfill workers. Even materials that have been classified as
medical waste will not always cause disease-they merely pose a risk that must
always be considered in handling, storage, transportation and disposal.
This information will outline current practices for
disposing medical waste, partially summarize the regulations covering medical
waste disposal, explain the specific and general risks that medical waste may
pose to you in your job, and suggest ways you can protect yourself from those
risks.
How Is Medical Waste Disposed?
The required disposal methods for medical waste depend on
the type of waste and on the nature of the facility that created it.
Medical waste disposal by health care facilities and
households is subject to regulation at the state level by the Louisiana
Department of Health and Hospitals (DHH) and the Louisiana Department of
Environmental Quality (DEQ). In addition, all employers except state and local
governments are required to dispose medical wastes according to regulations of
the federal government's Occupational Safety and Health Administration (OSHA).
These agencies' rules (which are summarized in more detail later) are similar.
They require that "sharps" (needles and syringes, scalpel blades,
etc.) should be placed in closed, leak proof containers (though these do not
have to be puncture-resistant). This type of container must be labeled or color-coded
as containing medical waste.
Red or orange are the colors used on containers to indicate
that they contain medical waste. Typically, hospitals use hard red plastic
containers for "sharps," and red trash bags for other medical waste,
however, other colors could be used and it is important to look at the labeling
or identification on the container. Another indicator of the presence of
medical waste, which may be used instead of or in addition to the red or orange
color code, is the "BIOHAZARD" symbol.
Medical waste from health care facilities must be treated in
a way that destroys its potential for causing disease, prior to disposing it in
a landfill. Acceptable treatment methods may include incineration, steam
sterilization (or autoclaving), and chemical disinfection. Waste that has been
treated, but that is still recognizable as medical waste (for example, waste
that has been autoclaved which is still in a red bag or sharps container), must
be labeled with the name of the facility that generated it, the type of
treatment method used, and the name or initials of the person in charge of
treatment.
Many landfills in Louisiana do not accept medical waste from
health care facilities unless it has been incinerated. Incinerated waste would
not be recognized as medical waste. Therefore, as a general rule, if you
encounter any red bags, red sharps containers, or packaging marked with the
biohazard symbol, in waste that is sent to your landfill, you should notify
your supervisor before handling them in any way.
Not all medical wastes are covered by regulations that
require this kind of labeling and treatment. The most obvious example is waste
generated by private households. Many diabetics, allergy suffers, dialysis
patients, and other people who receive medical care at home (not to mention
users of illegal intravenous drugs) have to dispose needles and syringes and
other medical wastes. Rules promulgated by the Louisiana Department of Health
and Hospitals require households to package their medical wastes in tightly
closed, wrapped containers before discarding them in household garbage.
However, these regulations frequently violated. Therefore, medical wastes will
be mixed with ordinary trash, and you may encounter it in connection with your
work.
What Regulations Govern the Disposal of Medical Waste?
In Louisiana, there are three (3) sources of regulations for
medical wastes: OSHA, the Louisiana Department of Health and Hospitals, and the
Louisiana Department of Environmental Quality.
Summary of OSHA Regulations
The following is a partial summary of OSHA regulations
regarding occupational exposure to blood borne pathogens, 29 C.F.R. Part
1910.1030. If your employer is covered by OSHA, it must make a copy of the
complete regulations and an explanation of their contents accessible to you. In
Louisiana, these regulation apply to all private employers and to federal
civilian employers. If the employer has any employees who can be reasonably
anticipated to be exposed to infectious material, it must follow these OSHA regulations.
According to OSHA's written enforcement procedures (OSHA Instruction CPL
2-2.44C, March 6, 1992), employees who handle medical waste are considered to
have occupational exposure. In general, the rules require employers to develop
exposure control plans, to adopt engineering controls and work practices that
minimize exposures, to provide handwashing facilities and personal protective
equipment, to provide training to workers, to provide hepatitis B vaccines free
of charge, to provide medical evaluation and follow-up to exposed workers, and
to keep medical and training records.
Under the OSHA rule, exposure means skin, eye, mucous
membrane (mouth and nasal) contact with blood or other potentially infectious
materials. Blood means human blood, blood products, or blood components. Other
potentially infectious materials include all body fluids in situations where it
is difficult or impossible to differentiate between body fluids.
Exposure Control Plan Covered employers must prepare an
"Exposure Control Plan." This plan must contain separate lists of job
classifications where some or all of the employees may be exposed and a list of
job tasks and procedures in which exposure may occur (whether or not personal
protective equipment is used). The Exposure Control Plan must also contain a
timetable for implementing various provisions of the regulations and a
description of the procedure that will be followed if an exposure occurs. The
plan must be made accessible to all employees.
Methods of Compliance Section (d) of 1910.1030 specifies the
procedures that must be followed by all employers to comply with the
regulation. "Universal precautions," an approach to infection control
that assumes that all blood and certain body fluids are infectious for HIV (Human
Immunodeficiency Virus which leads to AIDS), HBV (Hepatitis B Virus), and other
blood borne pathogens, must be followed. If the circumstances are such that
different body fluids cannot be distinguished from each other, all should be
treated as potentially infectious.
Employers are required to employ "engineering and
workplace controls" wherever possible to minimize or eliminate employee
exposure. Engineering controls either remove the hazard or isolate the worker
from exposure. An example of an engineering control is the use of a ventilated
cab on earth-moving equipment to protect workers from dust and aerosols.
Workplace controls alter the manner in which tasks are performed to reduce
exposure-for example, always cleaning equipment with implements or with high-pressure
hoses, rather than by hand. Employers are required to examine, maintain, and
replace engineering controls on a regular basis to insure their effectiveness.
Personal Protective Equipment Appropriate personal
protective equipment must be used to reduce risk of worker exposure. Employers
must make readily available at no cost to employees appropriate specialized
clothing or equipment to protect against exposure to blood and other
potentially infectious materials. Personal protective equipment must prevent
such materials from passing through to an employee's work clothes, street
clothes, undergarments, skin, eyes, mouth, or other mucous membranes under
normal conditions of use and for the duration of time that the equipment is in
use.
Personal protective equipment consists of, but is not
limited to, gloves, face shields, masks, and eye protection, gowns, aprons, and
similar items. Employers must ensure that appropriate personal protective
equipment is used and used correctly. Employers must also see to it that
personal protective equipment is properly cleaned, laundered, repaired,
replaced, or disposed as needed, at no cost to the employee.
The employer must ensure that employees observe precautions
for handling and using personal protective equipment, including:
§ removal of garments penetrated by blood and other infectious
material as soon as possible;
§ placing contaminated protective equipment in designated
areas or containers for storing, washing, decontaminating, or discarding each
day or shift;
§ replacing gloves if torn, punctured, contaminated, or if
their ability to function as a barrier is compromised;
§ utility gloves may be decontaminate for re-use if the
integrity of the glove is not compromised. However, they must be discarded if
they are cracked, peeling, torn, etc.;
§ wearing appropriate face and eye protection such as goggles,
glasses with solid side shields or chin-length face shields when splashes,
sprays, spatters, or droplets of infectious materials pose a hazard to the
eyes, nose, or mouth.
Handwashing and Hygiene Employers must provide handwashing
facilities that are readily accessible to all employees. When this is not
feasible, they must provide antiseptic towelettes. Employers must ensure that
employees wash their hands as soon as possible after removing gloves and other
personal protective equipment, or after contact with potentially infectious
material.
Disposal Methods for Medical Waste at Health Care Facilities
The rules provide requirements for handling contaminated sharps, including a
requirement that they be placed in a closed, puncture-resistant, leakproof,
color-coded (or biohazard-labeled) containers prior to disposal. If the
container can leak, it must be placed in a second closed, leakproof container.
Blood and other potentially infectious material (other than
sharps) must be placed in leakproof, color-coded (or biohazard-labeled)
container before it leaves the facility. If outside contamination occurs, or if
the container is punctured, it must be placed in another leakproof, labeled or
color-coded container.
Disposal of medical wastes must be in accordance with all
applicable federal, state, and local regulations.
Training All persons with a potential for exposure must be
provided with adequate training and information including general explanation
of the modes of transmission, symptoms, epidemiology, warning signals relating
to possible exposure, and procedures to follow if exposure occurs.
Hepatitis B Vaccine Covered employers must make available,
free of charge, and at a reasonable time and place, the hepatitis B vaccine and
vaccination series to all employees who are at risk of occupational exposure.
Employees may decline either antibody pre-screening or vaccination; if they
decline vaccination, they must sign a declination form.
If an Exposure Incident Occurs Employees should immediately
report exposure incidents. The employer is responsible for establishing the
procedure for evaluating exposure incidents.
Recordkeeping The employer must keep medical records and
records of training sessions. Medical records must be kept confidential (though
an employee and his or her representative may see and copy his own record on
request) and must be maintained for thirty (30) years after employment has
ended.
Training records, including the dates, content, names and
qualifications of trainers, and names and job titles of trainees, must be kept
for three (3) years.
Summary of Louisiana Department of Health and Hospitals
Regulations
This agency has regulations governing the packaging,
labeling, storage, transportation, and treatment of medical waste, contained in
the Louisiana Sanitary Code, Part XXVII.
Definitions and Exclusions -
The regulations define several categories-medical waste, infectious biomedical
waste, and potentially infectious biomedical waste. The latter is used most
extensively throughout the regulations, and is defined, in pertinent part, as
follows:
"...waste considered likely to be infectious by virtue
of what it is or how it may have been generated in the context of health care
or health care like activities."
"Potentially Infectious Biomedical Waste"
includes, but is not limited to the following:
1) Cultures and stocks of infectious agents and associated
biologicals, including cultures from medical and pathological laboratories, from
research and industrial laboratories.
2) Human pathological wastes including tissue, organs, body
parts and fluids that are removed during surgery or autopsy.
3) Human blood, human blood products, blood collection bags,
tubes and vials.
4) Sharps used or generated in health care or laboratory
settings.
5) Bandages, diapers, "blue pads," and other
disposable materials if they have covered infected wounds or have been
contaminated by patients isolated to protect others from the spread of
infectious diseases.
6) Any other refuse which has been mingled with potentially
infectious biomedical waste.
Eating utensils, animal carcasses and bedding, and
"very small quantities" (less than 250 grams or 1/2 pound) of human
or animal tissue, clean dressings, and clean surgical wastes from persons or
animals not known to be infected, are excluded from the definition of
potentially infectious biomedical waste. The last two categories of material
must be disposed in tightly closed plastic bags or other impervious containers.
Animal carcasses and tissues and wastes from large animals
must be disposed either as potentially infectious biomedical waste, or
according to regulations of the Livestock Sanitary Board. Carcasses, tissue,
and wastes of pets may be buried, rendered [cooked at a minimum temperature of
250 degrees Fahrenheit for at least thirty (30) minutes], incinerated, or
disposed either in accordance with these regulations or on the order of a
licensed veterinarian.
Packaging and Labeling - Potentially infectious biomedical waste (i.e., medical
waste) must be packaged in a manner that prevents exposure to the material.
Liquids must be in a sturdy, leak-resistant container. Sharps must be in a
closed, rigid, break-resistant, puncture-resistant container. Plastic bags and
other containers must be clearly labeled, impervious to moisture, strong enough
to prevent tearing or bursting under normal conditions, and closed prior to
transport. A second level of containment is necessary if the material is to be
stored prior to transport.
All containers of potentially infectious biomedical waste
must be labeled "Potentially Infectious Biomedical Waste,"
"Medical Waste," or "Infectious Waste." Untreated waste
must bear the name and address of the generator or transporter when it leaves
the generator's premises. Treated waste that is still recognizable must carry a
supplemental label to specify the treatment method used, the date of treatment,
and the name or initials of the person responsible for treatment. All labels
must be clearly visible and legible, and must be water resistant. Note: There
are no requirements in the DHH Regulations that state that the bags, boxes,
containers, etc., be a certain color.
Storage and Transport -
Potentially infectious medical wastes must be stored in a secure manner.
Compactors shall not be used for storage. Except for small quantities (defined
as a single package containing less than 11 pounds of waste other than sharps
or less than 2.2 pounds of sharps), wastes can be transported off the site where
they were generated only by transporters permitted by the State Health Officer.
Small quantity generators, including doctors', dentists',
and veterinarians' offices and private households, may transport small
quantities of properly packaged and labeled wastes to approved large quantity
generators, permitted storage facilities, or permitted treatment facilities
without meeting the requirements for transport and treatment that large
quantity generators must meet.
Transportation of potentially infectious waste (except by
small quantity generators, as described above) is governed by Part
XXVII.Chapter 7 of the regulations. This section contains provisions for
transporter permits; written contracts between generators and transporters;
vehicles used in transportation; transporter operation plans (including worker
safety and decontamination provisions), and delivery of potentially infectious
biomedical waste only to properly permitted facilities.
Special Rules Applicable to Households and Other
Small-quantity, Non-healthcare Facilities -
Households and other small-quantity, non-healthcare facilities may dispose
their waste in the ordinary trash. The waste must be packaged to assure that
there will be no leakage, even if the original package is violated (generally,
this means double bagging, or placing sharps containers in a second rigid
disposal container). Sharps must either be encased in plaster or in another
substance as approved by the State Health Officer, or placed in a sharps
container of standard manufacture or other similar container of a type approved
by the State Health Officer. This sharps container should then be placed in
another bag or other rigid container containing a greater volume of
non-infectious waste. Note: No labels or symbols are required on these
containers.
Treatment and Disposal -
Acceptable treatment methods for potentially infectious biomedical waste are
set forth in Part XXVII.Chapter 11 of the regulations. These include
incineration; steam sterilization [generally, autoclaving at least 248 degrees
Fahrenheit (120 degrees C.) and a minimum pressure of 15 psi for a minimum of
30 minutes, or longer if necessary]; disposal of liquids into a sanitary sewer
system that meets the requirements of Part XIII of the Sanitary Code; thermal
inactivation [dry heat of at least 320 degrees F. (160 C.) at atmospheric
pressure for at least 2 hours, excluding lag time]; chemical disinfection (use
of chemical agents that have been approved by the State Health Officer); and
irradiation (only with the written approval of the State Health Officer).
Sharps must be incinerated, encased in plaster or other
approved substances in a tightly closed container, or treated in some other
manner that renders them unrecognizable as medical sharps and practically
precludes the release of recognizable needles and syringes if compacted.
Once treated, potentially infectious biomedical waste may be
disposed in a permitted sanitary landfill in accordance with the Solid Waste
Regulations of the Department of Environmental Quality. As noted above, treated
and still recognizable medical waste must carry a supplemental label specifying
the treatment method and date, and the name or initials of the person
responsible for treatment.
On-site Storage and Treatment - Generators may store and treat their own potentially
infectious biomedical wastes, if they obtain a proper permit and comply with
substantive provisions of the regulations as to packaging, labeling, storage,
transportation, and treatment.
Enforcement -
These regulations are enforced by the Office of Public Health.
Summary of Louisiana Department of Environmental Quality
Regulations
Currently, the Solid Waste Regulations, Louisiana
Administrative Code Title 33, Part VII, Chapter 7, paragraph 711.D.1.e, deals
with medical wastes. The regulation states that infectious waste from
hospitals or clinics may be deposited in Type I or II landfills if it has been
properly packaged and identified and is treated by a method approved by the
Department of Health and Hospitals. Infectious waste is defined as follows:
"waste that contains pathogens of sufficient virulence
and quantity that exposure to it could result in an infectious disease in a
susceptible host."
The La. R.S. 30:2180 D., authorizes the Department of
Environmental Quality to promulgate rules and regulations for the
transportation, incineration, and disposal of medical waste.
What Are the General Risks Posed by Medical Waste?
The concern created by medical waste is that it can cause
infection and/or disease. In order for this to happen, several things must
occur. First, infectious agents (for example, viruses) must be present in the
waste. It is important to keep in mind that certain types of materials are
classified as medical waste because they might cause disease. Blood, for example,
is considered infectious because it might contain viruses. Any given sample of
blood or blood-soaked material may, in fact, be harmless.
Not only must infectious agents be present in the waste for
it to cause disease-they must also survive in the waste in large enough
quantities to be able to cause infection if an exposure occurs. The hepatitis B
virus (or "HBV"), for example, is usually present in the blood of
persons infected with hepatitis B in higher quantities than the AIDS virus (or "HIV")
is in persons infected with HIV. For this reason, it is much easier to contract
hepatitis than AIDS from exposure to infected blood. Further, HIV normally does
not survive for very long outside a living organism. Therefore, the chance of
contracting AIDS from contact with medical waste outside a health care setting
is considered to be remote by the Agency for Toxic Substance and Disease
Registry of the Public Health Service.
Second, an exposure has to occur in a manner that will be
effective in transmitting the disease. There are four basic ways that a person
can be exposed to infections: through the skin; through mucous membranes in the
eyes, nose, and mouth; by inhaling infectious agents; and by swallowing them.
Not all of these "routes" of infection will actually transmit a given
disease. For example, AIDS can only be transmitted by sexual contact; by
contact with the blood of an infected person on mucous membranes, broken skin,
or through needle sticks; or from a pregnant woman to her fetus. It cannot be
transmitted by inhalation or by touching an infected person.
Finally, in order for the exposure to cause disease, enough
of the infectious agent must be transmitted to the person who is exposed so
that his immune system cannot effectively protect him or her from the disease.
Even if the waste does contain a large enough concentration of a
disease-causing agent, and exposure does occur in a way that could transmit the
disease, disease may or may not develop. For example, AIDS can be transmitted
through being stuck by a needle that contains the blood of an HIV-infected
person. However, the chance of contracting AIDS from a single needle stick,
even if the needle does contain HIV-infected blood, has been estimated by the
Centers for Disease Control to be only approximately 0.4%, or 1 in 250. The
chances of becoming infected with hepatitis B from a single needle-stick, even
if the needle contains blood of an infected person, is between 6 and 30
percent. A person's chances of not contracting the disease from an exposure are
usually better if he or she receives prompt medical attention.
What Are the Specific Risks to Landfill Workers from Medical
Wastes?
The risk to landfill workers from medical waste that has
caused the most public health concern is that of contracting hepatitis B or
AIDS from needle-sticks or from infected blood or blood-containing fluids being
splashed or rubbed into open wounds, non-intact skin, or mucous membranes.
Some of the other diseases that could be transmitted through
both medical waste and ordinary household waste include the common cold,
"pink-eye" (bacterial conjunctivitis), chicken pox, and flu-all of
which can be transmitted by mucous membrane exposure, inhalation of airborne
particles from soiled articles, or inadvertent swallowing of particles after
handling soiled articles. Bacterial infections are less common communicable
diseases that can potentially be transmitted through cuts or abraded skin,
following handling of contaminated articles.
Drawing together information from a variety of sources, the
Agency for Toxic Substances and Disease Registry (a division of the United
States Public Health Service, or ATSDR), has attempted to quantify the risk of
disease caused by medical waste to workers. One of the categories of workers
for which these risks were examined was "refuse workers"-workers
involved in waste collection and disposal. This category includes landfill
operators. The only diseases for which enough data were available were
hepatitis B and AIDS.
AIDS can be transmitted in three ways-through exposure to
infected blood or blood products (for example, through a needle stick injury),
through sexual contact, or from a pregnant woman to her fetus. At writing,
there have been no documented cases of transmission of AIDS through contact with
contaminated surfaces or dried blood. The virus that causes AIDS dies rapidly
in normal environmental conditions outside a living host, making transmission
outside the health care setting unlikely. As of the date of the ATSDR study,
there had been no cases of HIV infection from medical waste reported in the
scientific literature.
Contaminated sharps, like used hypodermic needles, create
the greatest concern for AIDS transmission. However, the ATSDR study estimated
that, out of approximately 200,000 refuse workers in the U. S., less than 1
case of HIV infection per year is expected to result from injury from discarded
sharps.
Hepatitis B is a viral infection that causes acute and
chronic hepatitis, cirrhosis, and liver cancer. Symptoms include combinations
of anorexia, nausea, vomiting, abdominal pain, and jaundice.
Hepatitis B virus (HBV) is transmissible in the same ways as
the AIDS virus. As with AIDS, the greatest risk is from being cut or stuck by a
contaminated sharp. However, since HBV is much more concentrated in infected
blood than the AIDS virus (HIV) is, and since it is able to survive in the
environment for a longer period of time (up to 7 days at 77 degrees Fahrenheit
and 42% relative humidity)-HBV is more likely than the AIDS virus to be
transmitted by medical waste. The ATSDR still concludes, however, that
transmission of HBV outside a health care setting is a remote possibility.
In another study, dealing with a health care setting, the
federal Centers for Disease Control has estimated that 12,000 health care
workers whose jobs entail exposure to blood become infected with hepatitis B
each year, that 500-600 of them are hospitalized as a result of that infection,
and that 700-1,200 of those infected become carriers. Of the health care
workers infected with hepatitis, about 250 can be expected to die of hepatitis,
cirrhosis of the liver, or liver cancer.
However, landfill workers as a group face much lower risks
of becoming infected than health care workers do. The ATSDR study estimated
that in the 200,000 refuse workers nationwide, medical waste injuries from
discarded sharps can be expected to cause only between 1 and 15 cases of
hepatitis B infection per year.
What Can Be Done to Reduce the Risk of Infection?
Your risk of being infected by medical waste can be reduced
to a very low level if you obtain proper preventative medical care, follow safe
work practices, report any exposures promptly, and obtain medical care and
counseling if exposure does occur.
Preventative Medical Care
A safe and effective vaccine is available for hepatitis B.
According to the federal Centers for Disease Control, the vaccine provides
80-95% protection against hepatitis B. (It can also help prevent infection if
it is administered immediately after exposure to the HBV virus.) It consists of
a series of three (3) injections, usually in the arm, the second given one (1)
month from the first, and the third given six (6) months after the initial
dose. All employers covered by OSHA regulations must make this vaccine
available free of charge to workers who have occupational exposure to blood or
other potentially infectious material. In Louisiana, state and local government
employees are not covered by OSHA; however, your employer may provide this as a
service to employees. Other immunizations that may be appropriate are the
tetanus vaccine and immune globulin ("gamma globulin"). You should
consult a physician about whether or not to have these immunizations.
§ Each landfill should have standard operating procedures
(SOPs) for accepting, rejecting, and handling medical waste. Find out as much
as you can about the wastes you may encounter and what you should do if you
find them. For example, ask your supervisor what, if any, medical wastes are
disposed at your facility; what you should do if you encounter a red bag or
other biohazard; what personal protective equipment you should use, both
routinely and if you encounter a special hazard; and what you should do if you
are stuck with a hypodermic needle or are otherwise exposed to potentially
infectious wastes.
§ Follow your employer's SOPs and your supervisor's
instructions about reporting and handling medical wastes.
§ Be alert to potential hazards.
§ If you encounter a red bag, red sharps container, or something
marked with the biohazard symbol; or sharps, blood or blood-containing
material, human or animal parts; or other material that appears to be medical
waste, TREAT IT AS IF IT IS HAZARDOUS. Inform your supervisor before covering
it or handling it in any way. Your supervisor may want to reject the waste,
and, if so, will contact the hauler, or the person who disposed the waste, to
come pick it up.
§ Wear person protective equipment under circumstances in
which you might be exposed. Boots should have steel toes and puncture-resistant
soles. 6" lace-up boots provide added protection for the ankles. Gloves
should be worn whenever the hands may come in contact with hazards; leather
provides better protection than rubber against punctures. Arms and other skin
surfaces should be covered whenever the skin might be exposed to infectious
agents. Safety glasses and hard hats may also provide protection to the head
and face from splashes. Special equipment, such as respirators, face shields,
dust masks, boot covers, or impervious clothing may be necessary if a spill
occurs, if splashing or splattering is expected, or if another unusual hazard
arises.
§ Cover all cuts, abrasions, and other areas of non-intact
skin while on duty.
§ Avoid physical contact with medical wastes, whether they are
in red bags or sharps containers or not. If you are required to move these
items-for example, to separate them for pickup-use a shovel or other implement.
Never handle any wastes with your bare hands.
§ Be aware of the possible presence of medical wastes when
handling all wastes and when cleaning all machinery and equipment, and try to
avoid contact. In particular, be aware that sharps can become stuck in the
wheels and tracks of landfill vehicles, and can pose hazards to operators and
maintenance workers. Where possible, use some implement or cleaning method
other than your hands. If you do have to use your hands to clean or maintain
equipment, make sure that you are wearing gloves that minimize the chance of
being cut, and NEVER REACH WHERE YOU CAN'T SEE.
§ Avoid handling personal items, like pens, combs, etc., while
wearing gloves. Always wash your hands after removing your gloves, even if the
gloves have not been cut or punctured.
§ Always wash before eating, drinking, smoking, or putting
anything in your mouth, and before leaving work.
§ Change your clothes and boots immediately after work so that
you do not contaminate family members.
§ If you come in contact with infectious waste (for example,
if you are splashed with blood or blood-containing bodily fluids), wash your
hands and any exposed skin thoroughly in warm water and soap, or in waterless
antiseptic cleaner, if soap and water are unavailable.
§ Remove clothing, boots, and gloves that have been in contact
with infectious waste as soon as possible, taking care to avoid contact with
exposed skin surfaces. Use gloves to remove other items of clothing.
§ The risk of disease from clothing soiled with medical waste
is very low, but it should still be handled as little as possible. While
wearing gloves, place it in a leakproof bag prior to cleaning. Soiled clothing
should be handled with gloves and laundered according to manufacturer's
instructions. Boots and leather goods may be brush-scrubbed with soap and hot
water to remove contamination.
Report All Exposures Immediately
If you are exposed to infectious waste-including any time
that you are stabbed by a hypodermic needle or other sharp, or any time that
blood or other body fluid in waste comes into contact with a place where you
have an open wound; non-intact skin, or mucous membrane (eyes, nose, or
mouth)-report the exposure to your supervisor immediately, and try to make sure
that the incident is recorded. Wash the exposed area thoroughly with soap and
water, and apply a disinfectant such as alcohol or hydrogen peroxide. Your
employer may be able to trace the waste, which may make it possible to
determine how likely it is that the waste came from an infected individual (if
your employer is covered by OSHA, he must attempt to locate the source individual,
and attempt to obtain his or her consent to an HBV and HIV test). Further,
receiving prompt medical attention following exposure can be very important for
your own health.
Medical Care and Counseling after Exposure
You should receive prompt, confidential medical attention
following an exposure. If your employer is covered by OSHA, this follow-up care
and all necessary tests must be provided to you free of charge.
§ Particularly in the case of a needle stick or exposure by
another kind of sharp, vaccination for hepatitis B and/or a gamma globulin shot
may be recommended, if you have not already been immunized. These have been
shown to be effective at preventing infection if administered soon after
exposure.
§ A tetanus shot may be administered after any waste-related
cut incident.
§ Other tests, counseling, and treatment may be recommended,
depending on the circumstances of exposure and your medical history.
§ If your employer is covered by OSHA, the results of any HBV
or HIV test on the source individual must be made available to you, and you
must be given a written opinion by the healthcare professional who evaluated
you.
§ Accurate records should be kept of the exposure and of your
medical evaluation. Your medical records, including your HIV or HBV status, are
confidential. You have the right to see and copy these records on request.
With proper preventative care, safe work practices, prompt
reporting of exposures, and post-exposure medical attention and follow-up,
there is little likelihood that medical waste will harm you on the job.
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