MARSHALLTOWN MEDICAL & SURGICAL CENTER Marshalltown, Iowa

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1 MARSHALLTOWN MEDICAL & SURGICAL CENTER Marshalltown, Iowa ADMINISTRATIVE POLICY AND PROCEDURE Policy #: 163 Subject: Purpose: Policy: Pharmaceutical Waste Management Program Marshalltown Medical Surgical Center [MMSC] will comply with the Resource Conservation Recovery Act [RCRA] of MMSC is committed to providing a safe environment for patients, visitors, staff and the surrounding community. Specific responsibilities with regards to hazardous waste are denoted throughout this policy. This policy applies to facility employees and contractors who engage in any activities involving hazardous waste generation, management and disposal. This Hazardous Waste Management Policy is designed to prevent harm to health and the environment by providing a framework for safe, efficient and environmentally sound hazardous waste management. The policy will ensure that every effort is made to minimize the generation of hazardous waste and that all hazardous waste is properly managed and disposed of in accordance with the Environmental Protection Agency [EPA] regulations 40 CFR as well as state and local regulations. Marshalltown Medical Surgical Center s EPA # is IAD Additional Information: Hazardous Waste is defined under federal regulation as a solid waste that exhibits any of the characteristics of hazardous waste or is listed as a hazardous waste. Waste can be hazardous for one of three reasons: 1. Four types of RCRA listed waste are F, K, P, U, with a three digit identifier (e.g., F005, P039, U135): a. F listed, or non-specific-source wastes that are material-specific, such as solvents, generated by several industries. Waste code range from F001 to F039. b. K listed, or source-specific wastes from specifically identified industries and range from K001 to K161. c. P listed (acutely hazardous waste), or discarded commercial chemical products including off-specification products, container residuals, spill residue runoff, off-specification species, or active ingredients that have spilled or are unused and that have been, or are intended to be, discarded. Waste codes range from P001 to P205. For these acutely hazardous wastes, as little as 2.2 pounds of theses wastes generated in a given calendar month designates a facility as a large quantity generator. d. U listed, or discarded commercial chemical products including offspecification products, container residuals, spill residue runoff, offspecification species, or active ingredients that have spilled or are unused and

2 that have been, or are intended to be, discarded. Waste codes range from U001 to U It is a RCRA characteristic waste if it displays one of four hazardous characteristics in the federal regulations: a. Ignitability (40 CFR ) a waste that creates fires under certain conditions, is spontaneously combustible, and has a flash point of less than 140 degrees Fahrenheit, is an ignitable compressed gas, or is an oxidizer. The waste code is D001. b. Corrosivity (40 CFR ) a waste that is an acid or bases that is aqueous and has a ph less than or equal to 2 or greater than or equal to 12.5; or a liquid capable of corroding metal containers. The waste code is D002. c. Reactivity (40 CFR ) a waste that is unstable under normal conditions. A reactive waste can cause an explosion, toxic fumes, gases, or vapors when mixed with water. The waste code is D003. d. Toxicity Characteristics (40 CFR ) a waste that is harmful or fatal when ingested or absorbed. When toxicity characteristic wastes are disposed of on land, contaminated rain or liquid may drain (leach) from the waste and pollute ground water. 3. Satellite Accumulation Areas are areas designated for hazardous waste collection and temporary storage near the point of generation. When containers are filled they are picked up by Environmental Services and transported to a central storage area. 4. This policy does not include biological waste or hazardous chemicals that are not spent, outdated, or unwanted. This policy does not include chemical, chemotherapy, radiology and pharmaceutical hazardous waste. Roles and Responsibilities: 1. The Environmental Services Director has the overall responsibility for the Hazardous Waste Management Program, including waste collection, RCRA hazardous waste determination, packaging, storage, disposal, training, inspections, and record keeping. 2. Each affected employee and contractor is responsible for the proper management of hazardous waste in their laboratory or work area, including labeling of containers, segregation, inspections and maintenance of the area. 3. Employees and contractors are responsible for participating in annual hazardous waste training. Procedures: All pharmaceuticals being disposed of require a procedure for proper waste removal. This includes pharmaceuticals identified as hazardous by the Environmental Protection Agency [EPA]. Anytime a medication identified as hazardous by the EPA is disposed of it needs to follow the proper procedure. 1] All drugs on the MMSC formulary will be reviewed by Stericycle, Inc. to determine what the risk level [if any] of the medication is.

3 2] When new drugs are added to the formulary the pharmacy department will notify Stericycle, Inc. to determine if it should be added to the list of medications considered hazardous by the EPA and its rating. 3] Once it has been determined that a medication is considered hazardous, then the pharmacy department will label the medication packaging with the proper warning label to alert the hospital staff to be aware of special waste procedures. An alert [identification terminology] will also be displayed in the Pyxis at time of drug removal to indicate proper disposal of the hazardous pharmaceutical. Identification System [warning label]: Acutely Hazardous P-listed s Black Circle with white P Compatible Hazardous s Black Circle Incompatible s Black Circle with Orange Triangle Dual s Purple Circle Non-Hazardous s No label/identifier Identification Terminology in Pyxis : Acutely Hazardous P-listed s Dispose of in Black P Container Compatible Hazardous s Dispose of in Black Container Incompatible s Return to Pharmacy Incompatible Dual s Return to Pharmacy Dual Non-Hazardous s No label/identifier 4] Compatible Hazardous : These pharmaceuticals on the MMSC formulary will be identified with an Pyxis message, circular black sticker on the medication label and/or a sticker placed on the Pyxis bin to alert the caregivers that the medication and its packaging need to be disposed of properly. These medications are to be disposed of in a black waste container appropriately labeled. If Compatible Hazardous waste remains in a syringe, discharge the remaining drug into some gauze. The gauze is then placed into the black container and then the syringe is placed into the sharps container. Any item having contact with the drug [vials, IVs and tubing] should also be placed in the black container. Pyxis message: Dispose of in Black Container Sticker: Black Circle Refer to appendix B for complete listing. Example: TPN s, insulin products 5] Acutely Hazardous : Certain pharmaceuticals are considered acutely hazardous and are included on the EPA s P-List of hazardous chemicals. All P listed pharmaceuticals and their containers / packaging must be disposed of in specified containers labeled for P listed medications. This 1.5 Qt container will be black and specific for P listed medications ONLY. The medication will be identified with an Pyxis message, black sticker with white P inside the borders of a circle on the medication label and a sticker placed on the Pyxis bin to alert the caregivers that the medication and its packaging need to be disposed of properly.

4 Pyxis message: Dispose of in Black P Container Sticker: Black Circle with white P Examples of P listed medications on the formulary at MMSC are warfarin sodium [Coumadin ] and nicotine gum/patches/lozenges and their packaging. Refer to appendix A for complete listing. 6] Incompatible Hazardous : These pharmaceuticals cannot be collected in the same container due to EPA and DOT regulations [considered compressed gases, corrosives, or oxidizers]. The medications will be identified with an Pyxis message, black sticker with an orange triangle inside the borders of a circle on the medication container and/or a sticker placed on the Pyxis bin to alert the caregivers that the medication and its packaging need to be disposed of properly. Examples of these items on the MMSC formulary are Oxidizers [unused silver nitrate sticks], aerosolized inhaler canisters [Ventolin HFA/Hurricaine Spray/NTG Spray], Corrosives [Sporonox Oral Soln/Aromatic Spirits of Ammonia] and toxic [none identified at initial assessment, however will reassess as new items are added to the formulary]. POC or Pyxis message: Return to Pharmacy-Incompatible. Sticker: Black Circle with Orange Triangle Bag-up/Bag-down Return to Pharmacy program: o A Black Circle with Orange Triangle will be attached to the Pharmaceutical and also the baggie in which it will be supplied. o The waste items will be placed in baggie and then in Return to Pharmacy bin. o Pharmacy staff will place the waste into a designated incompatible container. Refer to appendix C for complete listing. 7] Dual waste is any pharmaceutical requiring hazardous pharmaceutical waste removal, which also is considered bio-hazardous waste. Dual Waste Containers would include live vaccines. These will be placed in areas that are prone to having this type of waste. Example would be Emergency Department. Bag-up/Bag-down Return to Pharmacy program: o Pharmaceuticals will be supplied in a baggie with a Purple sticker attached. o The waste items would be placed in baggie and placed in Return to Pharmacy bin. o Pharmacy staff will place the waste into a designated incompatible container. Pyxis message: Return to Pharmacy-Dual Sticker: Purple Circle Refer to appendix D for complete listing. 8] Trace Chemotherapy: Yellow containers are for trace chemo waste. These containers are for empty IVs that had chemotherapy in them. They must be empty. If there is any measurable medication left, this becomes hazardous pharmaceutical waste and is to be placed into black hazardous waste containers. The yellow containers are also used for personal protective equipment [gowns, gloves, protective eyewear, shoe covers, etc.]

5 empty tubing, wipes, empty syringes, empty chemo boxes and any other item used in the preparation or administration of chemotherapy. Trace Chemo Containers will be located in the pharmacy and on the Oncology unit. 9] Bulk Chemotherapy: Bulk chemotherapy waste is any chemotherapy that is not empty. This would include non-empty containers holding free liquid [vial, IV bag, and tubing], oral medications, overtly contaminated garments and spill cleanup material [gowns, goggles, gloves, rags, wipes]. All this waste should be placed into a black container. 9] Non-Hazardous : These pharmaceuticals [not labeled as hazardous] are not hazardous under EPA but still will collect and dispose of by placing waste into a blue container. If drug remains in a syringe, expunge into gauze, place the gauze into the blue container and the syringe into the sharps container. An example of non-hazardous waste would be wasting a partial dose of a tablet of a nonhazardous and non-controlled medication and IV solutions such as heparin, dobutamine, dopamine, and antibiotics. Glass ampoules, once broken open do not leave substantially sharp jagged edges and will be disposed of in the blue container if pharmaceutical considered non-hazardous waste. 10] Sewerable Waste: This would consist of Plain IV Solutions and controlled substances that are no longer usable. Plain IV Solutions: These are prepackaged that did not have a drug added to it Drain the solution to the drain and the bags are disposed of in the garbage. They include saline, lactated ringers, 5% dextrose, plasmalyte, potassium chloride, potassium phosphate, sodium phosphate, calcium, sodium bicarbonate, etc. Controlled Substances: Witness and waste to the drain, sink, toilet Once empty, the containers can be placed into the sharps container or blue nonhazardous Rx waste container. 11] Red Sharps containers will continue to be used for sharps disposal. 12] Regular Trash: Items that can be disposed of in the regular trash would include unit dose packaging [except for warfarin and nicotine], outside packaging and package insert, cardboard, plain IVs and tubing. 13] Movement of Containers: a) When a container is deemed to be full; it is dated at that time by nursing personnel. Full containers in the nursing areas are to be taken to their dirty utility rooms. b) The new containers will be located in the waste management room, along with the stickers that are required for labeling. The required labels/stickers will be located in an identified yellow folder near the storage of the new containers. It is required that new containers are labeled with appropriate stickers indicating the type of waste in the container and record the start date on the label. When a new container is assembled; an absorbent pad is placed into the bottom of the container, bag is inserted and then lid is securely fastened. ENS personnel who

6 T:\Data\Policies\AdminNew_2\adm163.doc moves the full container to the dirty utility area will be responsible for labeling the new container with the appropriate label. Place the container in the designated area on the unit. c) Environmental Service staff will check the dirty utility rooms in the nursing areas daily and will transfer full containers to the Waste Management Room. Originated by: Pharmacy Effective date: 1/12 Authorized by: Administration Date Review date: Revision date:

7 Pharmaceutical Waste Stream Management Labeled or Identified as Hazardous / Incompatible Rx by Pharmacy Sewer System Controlled Substances Hazardous Rx Dispose of in Black Container Incompatible Rx Return to Pharmacy - Incompatible Bulk & Trace Chemotherapy Rx Waste Non-Hazardous No Messaging Items that can be cut and poured down the drain Plain IV Solutions Solutions containing additives, such as: Potassium chloride Potassium phosphate Sodium phosphate Calcium Sodium bicarbonate All Controlled Substances must be rendered unrecoverable Follow written DEA and Facility Policies Remaining must be rendered Unrecoverable Discharge Rx following Policies Remove any remaining Rx from vials and discharge EMPTY vials can go into the SHARPS or Blue Nonhazardous Rx Waste Containers Hazardous items identified with a message or black dot Insulin Clindamycin Neo-Synephrine Rx in Syringe Discharge into gauze, gauze in container, syringe to SHARPS Acutely Hazardous items identified with a message or black P dot Coumadin (plus packaging) Nicotine (plus packaging) P Incompatible Rx Wastes Require Segregation to Meet DOT, Safety & Disposal Requirements Place in zip-lock bag Aerosols Inhalers with canister Oxidizers Unused Silver Nitrate Corrosives Glycopyrrolate Toxic Botox Chemotherapy Rx and containers that ARE empty Empty Syringes Gowns with chemo small amount of contamination Gloves Goggles Wipes Empty IVs / Tubing Empty Vials Chemotherapy Rx and containers that are NOT empty Chemo Agents IVs with Residual Chemo Agents Chemo Spill Cleanup Debris Vials with Residual Chemo Agents Tablets, caps etc. Not Labeled or Identified as Non-Hazardous Rx by Pharmacy Collect Full, Partially Full and Empty Rx Containers Examples Antibiotics Lidocaine Marcaine Heparin Miscellaneous Rx in Syringe Discharge into gauze, gauze in container, syringe to SHARPS Cut and Discharge to Drain Witness and Waste Remaining Rx to Drain Acutely Hazardous Dispose of in Black P Container Incompatible s Trace Chemotherapy Bulk Chemotherapy Non-Hazardous SHARPS Needles Empty syringes (See Above) Empty controlled substance containers REGULAR TRASH Empty Plain IVs and Tubing Boxes, outside packaging and blister packs (except for Coumadin and Nicotine packaging) HAZARDOUS & INFECTIOUS A combination of of both unused Hazardous Waste and an an Infectious Waste Return to to Pharmacy Dual message