Hazardous Waste Management with the Healthcare Industry

Transcription

1 Hazardous Waste Management with the Healthcare Industry Presenter: Kurtis Drake Technical Account Manager Compliance Driven Solu=ons 2011 PSC Environmental Services, LLC, Now a Division of Stericycle Environmental Solutions

2 Topics Why increased emphasis placed on pharmaceutical waste? What are pharmaceutical wastes? Where is pharmaceutical waste generated? What does a successful implementation waste program look like? What about household pharmaceutical wastes?

3 Why Pharmacue=cals? Why Now? Down the sink RCRA RX Drugs in the Drinking Water USGS Report of 47 Metro Drinking Water Supply Disposal PracKces and POTW lack of treatment ability In the red bag /sharps In the trash Autoclave Municipal Landfill ~ 25% = RCRA Hazardous, NIOSH and OSHA Regulated No Statute of LimitaKons, Fines, Civil, Criminal and Personal LiabiliKes Joint Commission AudiKng

4 What is pharmaceu=cal waste? NON- RETURNABLE - No longer usable for their intended purpose &/or has no return credit value ParKally dispensed AMPULES AND VIALS (ParKal bo_les of tablets, capsules and liquids are accepted for return) Items which do not meet published manufacturing return criteria Unlabeled or unidenkfiable by healthcare provider Mixed inseparably with other pharmaceukcals Damaged or contaminated container Manufacturer sample, loose pills Repackaged by healthcare provider Items sold on a non- returnable basis EPA Generator is responsible for making the waste determina8on 40 CFR Partners in PharmaceuKcal Waste Compliance

5 Where is Pharmaceu=cal Waste Generated? Pharmacy IsolaKon Rooms Laboratories PaKent Care Units OperaKng Rooms Ambulatory Oncology Emergency Rooms Satellite Medical Clinics/ Surgery Centers

6 Healthcare Waste Materials PharmaceuKcal and Laboratory Waste Non- Viable PharmaceuKcals Laboratory Chemicals Compounding Waste Chemo Waste / Trace Chemo Waste Hazardous / Non Hazardous PharmaceuKcals IV Bags Total Parenteral NutriKon (TPN) Bags Maintenance Areas Aerosols Paints Oils Solvents Corrosives Other Industrial Products Universal Waste Bulbs and Ba_eries Ewaste Other Areas Photographic Waste Silver recovery processing Lead Shields (Radiology) SterilizaKon Tape (Lead) EKG Leads (Silver Chloride) Industrial Cleaning Field Services Oil/Water Separator Maintenance Petroleum Tank Cleaning Emergency Response Needs Mercury, Chemical, Petroleum and Biological

7 Regulated Hazardous Rx CharacterisKc Materials D Codes D001 Ignitable - (Flash point <140* F, >24% alcohol, strong oxidizers) D002 Corrosive - (ph < 2 or >12.5) D003 Reac=ve (to air and water, ie. Picric Acid and Clinical Test tablets like IcoTest) D004 D043 Toxic - 10 of 40 Toxicity CharacterisKc Chemicals and Heavy Metals) ie: Barium, Silver, Chromium Listed Materials P & U Codes P Listed Materials Acutely Toxic Materials Sole AcKve Ingredient Regulated Empty Containers All contents have been removed that can be removed through normal means & no more than 3% by weight remains Residues removed from container must be managed as hazardous waste U- Listed Materials Toxic Materials Sole AcKve Ingredient

8 Examples of Listed Pharmaceu=cals P001 Warfarin >0.3% P012 Arsenic Trioxide P075 NicoKne P188 PhysosKgmine Unique to a few States P081 Nitroglycerin P042 Epinephrine U188 Phenol U200 Reserpine U201 Resorcinol U205 Selenium Sulfide U206 Streptozotocin U237 Uracil Mustard U248 Warfarin <0.3% U010 Mitomycin U035 Chlorambucil U058 Cyclophosphamide U059 Daunomycin U089 DiethylsKlbestrol U129 Lindane U132 Hexachlorophene U150 Melphalan D001 Alcohol D009 Thimerosal D011 Silver Nitrate D024 m- Cresol And many more

9 Where does a Program Start? Formulary Waste Characteriza=on NDC Number, Product Name, Dose, Size of Packaging Partners in PharmaceuKcal Waste Compliance

10 Chemotherapy Waste Summary Eight chemotherapy agents are U- listed; one is P- listed (Arsenic Trioxide) Empty P waste containers (IV bags) must be treated as RCRA Hazardous Waste All other chemotherapy drugs are not listed wastes, but several are ignitable Most are listed as a NIOSH Toxic, EPA recommends they be managed as Hazardous Waste Partners in PharmaceuKcal Waste Compliance

11 Key Stakeholder Involvement Director of Nursing Director of Environmental Services Successful Program Development Director of Safety Compliance Director of Materials Management Director of Pharmacy

12 Healthcare Services Program Rx Waste CharacterizaKon Program Design SOP Development Program ExecuKon and Training Monitor and Improve Adaptable Program Design Formulary Waste ClassificaKon SegregaKon Plans AccumulaKon Area IdenKficaKon CollecKon & Storage Compliance Comprehensive Program ExecuKon EPA Generator Status and Requirements CollecKon, SorKng, Packaging OpKons TransportaKon & Disposal Sustainable Disposal On- going Program Support Dedicated Healthcare Support Team Healthcare Service System (HSS) HC Employee Rx Waste Program Training / CommunicaKon Steering Commi_ee

13 Segregate at Point of GeneraKon Pharmacy Hazardous Rx is collected in BLACK waste container Hazardous P- List Aerosols Non- hazardous Rx is collected in White/Blue container Aerosols / Inhalers are collected in separate container Containers are moved to Central AccumulaKon Area

14 Pharmacy Waste Iden=fica=on Partners in PharmaceuKcal Waste Compliance

15 Rx waste colleckon containers - Pharmacy

16 Collect all as RCRA PaKent Care areas Rx is collected in BLACK waste container P List is collected in separate container OR baggies Aerosols / Inhalers are Returned to Pharmacy Empty Non P- coded waste is managed as trash Containers are moved to Central AccumulaKon Area

17 RCRA Waste O]en Disposed as Trash Maintenance Waste Aerosols Electronics Oil Paint Flammable Solvents Corrosives Drain Opener Toxic PesKcides, InsecKcides Light Bulbs Ba_eries Chlorine Sterilants Hydrogen Peroxide PerocyaceKc Acid PeraceKc Acid Corrosives AceKc Acid Sodium Hydroxide Liquid Drain Openers Degreaser / Cleaner Lime and Scale Remover Pool/Fountain Acids Lye Detergents FLAMMABLES Hand SaniKzer Adhesives Nail Polish/Polish Remover Aerosols Alcohol/Betadine 17

18 One Stop - Total Waste Management PharmaceuKcal Waste Hazardous Waste Regulated Medical Waste Universal Waste Facility Maintenance Wastes Emergency Response Services Mercury, Chemical, Petroleum and Biological Field Services Oil/Water Separator Maintenance Petroleum Tank Cleaning E- Waste Laboratory Waste

19 PSC Healthcare Clients with Successful Programs 19

20 Household Pharmaceu=cal Waste Director of Nursing Director of Environmental Services Successful Program Development Director of Safety Compliance Director of Materials Management Director of Pharmacy

21 Household PharmaceuKcal Waste CollecKon Open done in conjunckon with a Household Hazardous Waste (HHW) colleckon day event Households are exempt from business regulakons PharmaceuKcal amnesty day held at school, fairgrounds, medical center, etc. Vendor sets up a colleckon table and segregates materials as residents drop them off

22 QuesKons?