Infectious Waste Policies and Procedures Manual Idaho State University 2002 Edition

Transcription

1 Infectious Waste Policies and Procedures Manual Idaho State University 2002 Edition Chapter 1 - Introduction The purpose of this manual is to provide important information about infectious waste for Idaho State University. Proper infectious waste management is important in order to provide healthy and safe working conditions for faculty, staff, and students; to protect the environment, and ensure compliance with applicable federal, state, and local laws and regulations. If there are situations that this manual does not address, or if questions arise regarding the procedures it contains, contact a hazardous waste specialist at the ISU Technical Safety Office. For emergency situation please refer to the table of phone numbers at the FRONT of this manual. Please note that this document is not a general infectious material safety manual. Safe acquisition, storage and use of infectious materials is handled by the College, Department, or other applicable unit within the University, with guidance by the ISU Campus Safety Committee. This manual is applicable only to the generation, minimization, storage, and disposal of infectious waste. Nevertheless, many of the afe work practices and information identified in this manual for the handling of waste are applicable to infectious materials in general. General compliance information for blood-borne pathogens (i.e. HIV & HBV) can be found in Title 29 of the Code of Federal Regulations, Section and the Idaho General Health and Safety Standards sub-section This manual was prepared for use within ISU. It is intended for use by, and applies to, ISU personnel. If this manual or any portion of it is used elsewhere, neither its authors nor the University accept responsibility for its contents. Chapter 2 - Applicability Many departments and facilities at Idaho State University work with biological agents and therefore produce infectious or potentially infectious waste. Academic units include: Biology, Nursing, Pharmacy, Idaho Dental Education Program, and Dental Hygiene. Other entities include: Student Health Center, Family Medicine, Technical Safety Office, and Transportation Services. Also, bodily fluids (blood) resulting from accidents shall be considered infectious waste, regardless of where the accident occurs on campus. Students in academic laboratories should be aware of infectious waste policy and procedures to prevent the mishandling and spread of infectious waste. Chapter 3 - Definitions Animal Wastes include contaminated carcasses, body parts and bedding of animals known to have been exposed to infectious agents during research, production of biologicals, or testing of pharmaceuticals. Bio-hazardous waste: see Infectious Waste Blood-borne Pathogens are pathogenic microorganisms present in human blood or other potentially infectious material and which can cause serious or fatal disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV), hepatitis C virus (HCV), and the human immunodeficiency virus (HIV). Code of Federal Regulations (CFR) is a set of Federal laws, which include regulations pertaining to OSHA Blood-borne Pathogens (title 29), and waste transportation (title 49). Page 1

2 Cultures and Stocks of Infectious Agents and Associated Waste are biological agents from humans or pathogenic to humans from the following sources: Medical, microbiological, and pathological laboratories Biological media preparation areas (stockrooms): cultures, culture dishes, and inoculation tubes Devices used to transfer, inoculate, and mix cultures Human blood and blood product, serum, plasma, and other bodily fluids Exposure Incident is any specific eye, mouth, other mucous membrane, non-intact skin or parenteral contact with blood or other potentially infectious material that results from the performance of a University Personnel s duties (contact with intact skin does not necessarily constitute an exposure incident). Human Blood and Blood Product is any blood, serum, plasma, and other bodily fluids. Infectious Waste, also known as bio-hazardous waste or medical waste, is biological wastes capable of producing an infectious disease in humans. Furthermore, conditions apply that include considerations for sufficient virulence, dose, portal of entry, and resistance of host. In other words, to be classified as an infectious waste it must contain a sufficient quantity of a pathogenic organism with sufficient virulence to cause an infection in a susceptible host. Non-disposable linen articles are not classified as waste, but must be handled safely as to prevent any further spread of potentially infectious agents. Waste that could potentially contain infectious materials shall be treated as infectious waste. Isolation Waste is waste generated from the isolation of persons with a communicable disease like Hepatitis or HIV. Medical Waste: see Infectious Waste Occupationally Exposed Employees are any persons classified as University Personnel who may have reasonably anticipated skin, eye, mucous membrane or parenteral (i.e., under the skin) contact with human blood or other potentially infectious materials resulting from the performance of their duties. Other Potentially Infectious Materials are any of the following body fluids: Semen Vaginal secretions Cerebrospinal, synovial, pleural, pericardial, peritoneal, and amniotic fluids Fluid visibly contaminated with blood All body fluids in situations where it is difficult or impossible to differentiate between fluids Any unfixed tissue or organ (other than intact skin) from a human (living or dead) HIV-containing cell, tissue and organ cultures HIV- or HBV-containing culture medium, blood and organs Tissues from experimental animals infected with HIV or HBV Pathological Wastes are those generated during surgery, biopsy, and autopsy including: tissues, body parts, and bodily fluids. Sharps are any instrument capable of easily penetrating skin with or without infectious agents is considered a sharp. These include and are not limited to: hypodermic needles, syringes, scalpel blades and pipettes, lancets, broken glass, or glass instruments that could break during handling. Technical Safety Office (TSO) the ISU unit that is responsible for overseeing and disposing of hazardous wastes including chemical and infectious wastes. Page 2 of 7

3 University Personnel means faculty, staff, other employees, students, student employees, physicians, patients, visitors, and volunteers associated with the University. Chapter 4 - Procedures for Infectious Waste 4.1 Containers 65 gallon, reusable containers with specific-type bags are generally provided by the TSO or infectious waste disposal company. Containers can be a volume other than 65 gallons, for the purpose of convenience, but they must be rigid, leak resistant, impervious to moisture, of sufficient strength to prevent tearing or bursting during use and transportation, and labeled properly. Sharps shall be disposed of immediately after use in an impervious, rigid, and puncture-resistant container. 4.2 Accumulation and Management at Generation Sites University personnel shall be responsible for the careful segregation of infectious and noninfectious waste and disposal of infectious waste in an appropriate container as described above, all of which shall occur at the site of generation or designated control site. Needles shall not be recapped, bent, clipped, broken, or manipulated in any way. Infectious waste bags within the container shall not be filled in a manner that would exceed the bag s weight or volume capacity. Furthermore, the bag must be closable and not exceed the weight limit set by the disposal company. All containers storing and transporting infectious material shall be labeled with the infectious waste bio-hazard symbol (see front cover of manual). Infectious waste labels of any kind shall not be disposed of in regular trash without defacing it. All persons handling infectious waste shall take all precautions in terms of person protective equipment (gloves, apron, goggles, and respiratory apparatus as necessary) and have proper training in infectious waste handling. Noninfectious biological or medical waste may be disposed of in regular trash containers. Research cultures, stocks, and other articles containing live pathogenic microorganisms shall be sterilized appropriately by autoclaving or chemical sterilization. More critical infectious waste may be sterilized to provide an additional measure of safety. University Personnel that need to inject insulin or other medicines, may contact TSO for a sharps container and proper disposal at no charge. 4.3 Storage Untreated infectious waste should be stored in a designated area for a minimal period of time. Storage areas must comply to the following: Protected from animals and weather; Secured to deny access by unauthorized persons; Marked with a standard and prominent, infectious waste warning sign provided by TSO. Provided with an ABC rated fire extinguisher 4.4 Collection and Transportation of Infectious Waste All infectious waste shall be collected by University Personnel for proper disposal. Disposal of infectious waste into normal waste containers is prohibited. Infectious waste generators have several options for collection, based on relevant circumstances and convenience. Frequent generators may make arrangements with the TSO for routine pick-ups from a designated area. In such agreements, the generator is advised to notify TSO of a pick-up in advance to allow sufficient time for response. Departments may also provide their own transportation of waste to the designated infectious waste storage shed located behind the Dental Hygiene Building (Building #37), with permission from TSO. Occasional generators may request pick-ups from TSO at any time. Untrained personnel shall not transport infectious waste and transportation must be done using University vehicles. Page 3 of 7

4 4.5 Disposal Infectious waste is transported by a disposal company to an ISU approved treatment facility. Disposal costs shall be born by TSO provided no abuse of the service occurs. 4.6 Documentation The disposal contractor shall be responsible for providing documentation to the TSO verifying that each container of infectious waste has been received and treated or incinerated. 4.7 Preparedness for Spills or Leaks Personal protective equipment (PPE) including: gloves, apron, and mask shall be available in all areas where infectious waste is generated or stored. A spill kit containing PPE, disinfectant, and absorbent material shall be kept in the generation and storage areas. All University personnel shall wear appropriate PPE when handling infectious waste. Materials generated from spill or leak clean-up shall be handled as infectious waste. 4.8 Monitoring The TSO shall be responsible for performing periodic inspections of equipment and storage areas, and if unsafe conditions are found, providing written or oral reports of observations and recommendations to the Campus Safety Committee. 4.9 Sterilization Sterilization is the processes by which any living organisms present on some object or surface are eliminated. This is generally done by autoclaving, which provides the object being sterilized with high temperature and heat Waste Minimization The amount of infectious waste generated at ISU should be minimized to reduce the environmental impact of disposal and reduce the amount paid in disposal costs. The following are ways to minimize infectious waste generation: Whenever possible, limit the amount of material you purchase that will eventually be disposed of as infectious waste. In some circumstances, there are alternative materials or methods to a procedure that would result in the production of less infectious material than other procedures Infectious Waste Mixed with Hazardous Chemicals Special circumstances for research purposes may result in infectious waste mixed with a RCRA hazardous chemical waste and shall be disposed of as RCRA hazardous chemical waste. If this occurs, TSO should be notified. RCRA hazardous chemical waste and infectious waste shall not be combined intentionally for disposal. Page 4 of 7

5 Chapter 5 - CDC Guidelines for Pathogenic Organisms Compliance suggestions proposed by the Centers for Disease Control (CDC) as they pertain to Idaho State University are outlined in this section. These CDC suggestions specifically address the safety and security recommendations for particular pathogenic organisms, but are not federal, state, or local code. 5.1 Bio-safety Levels The following table is a classification system proposed by CDC (Centers for Disease Control) for levels of precautionary measures and security levels for pathologic agents; BSL refers to Bio-safety Level. This table is from in CDC s Bio-safety in Microbiological and Bio-medical Laboratories (BMBL) 4th edition (section III). BSL Agents Practices 1 Not known to consistently cause disease in healthy human adults. 2 Associated with human disease. Hazard: percutaneous exposure, ingestion, mucous membrane exposure. 3 Indigenous or exotic agents with potential for aerosol transmission; disease may have serious health effects. 4 Dangerous/exotic agents that pose high risk of life threatening disease; aerosol transmission, or related agents with unknown risk of transmission. Standard animal care and management practices, including appropriate medical surveillance programs. ABSL-1 practices plus: Limited access Biohazard warning signs Sharps precautions Biosafety manual Decontamination of all infectious wastes and of animal cases prior to washing ABSL-2 practices plus: Controlled access Decontamination of clothing before laundering Cages decontaminated before bedding removed Disinfectant foot bath as needed ABSL-3 practices plus: Entrance through change room where personal clothing is removed and laboratory clothing is put on; shower on exiting All wastes are decontaminated before removal from the facility Safety Equipment Primary Barriers As required for normal care of each species. ABSL-1 equipment plus primary barriers: containment equipment appropriate for animal species; PPE: laboratory coats, gloves, face and respiratory protection as needed. ABSL-2 equipment plus: Containment equipment for housing animals and cage dumping activities Class I or II BSCs available for manipulative procedures (inoculation, necropsy) that may create infectious aerosols. PPE: appropriate respiratory protection ABSL-3 equipment plus: Maximum containment equipment (i.e. Class III BSC or partial containment equipment in combination with full body, air-supplied positive pressure personnel suit) used for all procedures and activities Facilities (Secondary Barriers) Standard animal facility No recirculation of exhaust air Directional air flow recommended Hand washing sink recommended ABSL-1 facility plus: Autoclave available Hand washing sink available in the animal room Mechanical cage washer used ABSL-2 facility plus: Physical separation from access corridors Self-closing, double-door access Sealed penetrations Sealed windows Autoclave available in facility ABSL-3 facility plus: Separate building or isolated zone Dedicated supply and exhaust, vacuum and decontamination systems Other requirements outlined in the text Page 5 of 7

6 5.2 Pathogenic Bacterial Agents The following is a categorization of pathogenic bacterial organisms by their recommended bio-safety level. With exceptions, all of the following are bio-safety level 2 for activities using clinical materials and diagnostic quantities of the organism. Name of Bacterial Organism Bacillus anthracis Bordetella pertussis Brucella abortus, B. canis, B. melitensis, B. suis Burkholderia pseudomallei Campylobacter jejuni, C. coli, C. fetus Chlamydia psittaci, C. pneumoniae, C. trachomatis Clostridium botulinum Clostridium tetani Corynebacterium diphtheria Escherichia coli Francisella tularensis Helicobacter pylori Leptospira interrogans Listeria monocytogenes Legionella pneumophila Mycobacterium leprae Mycobacterium spp. except M. leprae, tuberculosis, and bovis Mycobacterium tuberculosis, M. bovis Neisseria gonorrhoeae Neisseria meningitides Salmonella spp. except S. typhi Salmonella typhi Shigella spp. Treponema pallidum Vibrio cholera, V. para-haemolyticus Yersinia pestis Exception BSL 3 for production quantities or concentrations of cultures, and for activities with a high potential for aerosol production. BSL 3 for large-scale production operations. BSL 3 for all manipulations of cultures. BSL 3 for production quantities of toxin, or activities with a high potential for aerosol production. BSL 3 for all manipulations of cultures and experimental animal studies. BSL 3 for production quantities of toxin, or activities with a high potential for aerosol production. BSL 3 for propagation and manipulation of cultures BSL 3 for production quantities or concentrations, or Page 6 of 7

7 5.3 Pathogenic Fungal Agents The following table is a categorization of pathogenic fungal organisms by their recommended bio-safety level. With exceptions, all of the following are bio-safety level 2 for activities using clinical materials and diagnostic quantities of the organism. Name of Fungal Organism Blastomyces dermatitidis Coccidioides immitis Cryptococcus neoformans Histoplasma capsulatum Sporothrix schenckii Pathogenic members of the genera: Epidermophyton, Microsporum, Trichophyton Misc. molds: Penicillium marneffei, Exophiala dermatitidis, Fonsecaea pedrosoi, Ochroconis gallopavum, Claduphialopora bantians, Ramichlorisium machenzieim Exceptions BSL 3 for propagating and manipulating sporulating cultures, or processing environmental materials (soil) suspected to contain the fungi. BSL 3 for propagating and manipulating cultures, or processing environmental materials (soil) suspected to contain the fungi. 5.4 Pathogenic Viral Agents The viral agents mentioned by the Centers for Disease Control are not relevant for the minimal viral use at I.S.U. Further information about CDC regulations pertaining to pathogenic viral agents can be found in CDC s Bio-safety in Microbiological and Biomedical Laboratories (BMBL) 4th edition at: END OF MANUAL Page 7 of 7