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HLD Waste Management Cytotoxic Waste Management Lab Waste Recycling Jack Rogers – MHS Safety Manager WSHSC January 28, 2011
HLD Waste Management
Cytotoxic Waste Management
Lab Waste Recycling
Jack Rogers – MHS Safety Manager
WSHSC January 28, 2011
HLD Waste Management
Cidex OPA
OPA considered Category A toxic substance.
Designates as WA State toxic
Requires waste treatment prior to discharge or off-site disposal.
HLD Waste Management
Cidex OPA
Typical in 4-8 gallon scope washers.
Neutralized in adjoining sinks or in unit.
Need OPA spill kits including neutralizing equipment.
Adequate ventilation, PPE and Emergency wash facility
HLD Waste Management
Cidex OPA
TBG Logs required
TGH-MBH=3123 lbs
ALH=1543 lbs
GSH=1709 lbs
BAKER ASC=2985 lbs
MBCHC ASC=2452 lbs
Gig Harbor ASC=1009 lbs
Covington ASC=1668 lbs
MD Offices=263 lbs
MHS Total=14751 lbs
HLD Waste Management
Cidex OPA
TBG Costs $3 per Gallon
1765 Gallons
$5295
Off-Site Disposal50 Gallons/ Drum
35 Drums*$400/drum
$14,000
HLD Waste Management
Glutaraldehyde
Typical in 8-12 gallon scope washers.
Neutralized in adjoining sinks or in unit.
Need spill kits including spill procedures in accordance established WA State Emergency Response Standard.
Adequate ventilation, PPE and Emergency wash facility
HLD Waste Management
Glutaraldehyde
Considered Category C toxic substance.
Designates as WA State toxic
Requires waste treatment prior to discharge or off-site disposal unless permitted by local AHJ.
HLD Waste Management
Glutaraldehyde
TBG Logs required
Covington MOB
20 Gallons 28 Day=2027 Pounds
Allenmore MOB
8 Gallons 14 Day=1726 lbs
MHS Total=3753 lbs
HLD Waste Management
Glutaraldehyde
TBG Costs $3 per Gallon
449 Gallons
$1347
Off-Site Disposal50 Gallons/ Drum
9 Drums*$400/drum
$3600
HLD Waste Management
Sterrad Plasma Systems
Typical in Central Services and Surgery departments
Hydrogen peroxide >50%
PPE and Emergency wash facility
D001, D002 Waste Codes
HLD Waste Management
Steris Systems
Typical in Central Services and Surgery departments
Recently received FDA approval back as System 1E
Peracetic acid 35%
PPE and Emergency wash facility
D001, D002 Waste Codes
Case Study – Bladder Cancer Treatment Waste Management
Treatment of bladder cancer in urology physician offices as well as surgery includes hazardous drugs.
BCG
Mitomycin U listed cytotoxic agent
Case Study – Bladder Cancer Treatment Waste Management
Employees treating all wastes as trace chemotherapy including
Biohazardous - BCG Mitomycin U listed
cytotoxic agent Question: What to do with
urine contaminated with cytotoxic agent (bulk waste)?
Case Study – Bladder Cancer Treatment Waste Management
Bulk Chemotherapy – Send to RCRA approved incinerator – No sharps
Trace Chemotherapy – Sent to Stericycle municipal waste incinerator, including sharps, gowns, gloves, empty bags, tubing.
Question: What to do with urine contaminated with cytotoxic agent (mixed bulk waste)?
Case Study – Bladder Cancer Treatment Waste Management
Operating rooms – Procedures instillation of Mitomycin in bladder. Removed in recovery area.
First had staff empty urine/mitomycin in hopper sink
Developed a mixed waste profile for Mitomycin and urine. Will be incinerated at RCRA approved incinerator.
Case Study – Bladder Cancer Treatment Waste Management
DOSH complaint and compliance inspection with respect to the bladder procedure
Complaint originated from recovery and surrounded employees not certified in chemotherapy handling.
Case Study – Bladder Cancer Treatment Waste Management
Findings by DOSH
Nurses (two involved recovery of these patients) had been medical oncology RN in past.
Certification not required but competent to their jobs involving chemotherapy
All employees involved in these procedures need to be competent.
We were criticized but didn’t receive a citation for our practices but probably would have if a regulation existed.
Case Study – Bladder Cancer Treatment Waste Management
Findings by DOSH General citation
received for not updating Exposure Program annually.
DOSH compliance officer indicated public hearings on this subject soon.
Case Study - Lab Waste Management Recycling
Solvents
Xylene
480 Gallons-3500 lbs/year
Alcohol
380 Gallons-2500 lbs/year
Question: Need to reduce waste and reuse product?
Case Study - Lab Waste Management Recycling
CBG Biotechnologies
Recycles Xylene and Alcohol both
Still bottoms into waste poly containers for disposal.
Costs $25K
Case Study - Lab Waste Management Recycling
Cost Benefit Xylene
R 480 Gallons-3500 lbs/year
D 130 Gallons-930 lbs/year
Saved 2570 Lbs Waste
Alcohol
R 380 Gallons-2500 lbs/year
D 130 Gallons-850 lbs/year
Saved 1650 Lbs Waste
Other savings – Pollution prevention, product costs, waste generation
Case Study - Lab Waste Management Recycling
Formalin
WA State Toxic
Requires treatment by generator or off-site disposal
580 Gallons=4850 Lbs Per Year
Question: Need to reduce waste and reuse product?
Case Study - Lab Waste Management Recycling
CBG Biotechnologies
Recycles formalin
Still bottoms into waste poly containers for TBG.
Costs $25K
Case Study - Lab Waste Management Recycling
Cost BenefitR 580 Gallons-4850 lbs/year
D 159 Gallons-1330 lbs/year
Saved 3520 Lbs Waste 73%
159 gallons neutralized = $640
Other savings – Pollution prevention, product costs, waste generation
Jack Rogers 253-403-2084
Safety Manager/Acute Care Safety Officer
Don Balzarini253-403-9168
Ambulatory Safety Officer
Phil Amundson 253-403-2070
MHS Industrial Hygienist
Tom Armstrong 253-697-2269 Good Samaritan Safety Coordinator
MHS Safety Contacts
