Management of Medical Waste at Residential Facilities


Nursing homes, assisted living facilities, psychiatric hospitals, disabled persons’ facilities, old-style convalescent homes - they’re all similar. All have residents for an extended period (not just a few days as in a hospital) and all have medical staff (mostly some form of nurses). Care is not as advanced or complicated as what happens in a comprehensive hospital, but biohazardous waste can be produced.

Most waste generated at these facilities is not hazardous or regulated and differs little from waste produced in an apartment complex. However the rules for medical waste management that apply for households do not apply here. For instance, while it is acceptable for home residents to dispose of used needles in the regular trash, nursing homes, etc. must act more like hospitals and doctor offices.

Segregation is the key to controlling waste disposal costs. Over 80 percent of the waste generated can be classified as Municipal Solid Waste (MSW) and go to a landfill or wherever your local authority takes waste from homes and office buildings. You just to make sure your employees and residents do not put any regulated or potentially hazardous waste in containers intended for MSW. This waste can be placed in an outdoors dumpster and you may wish to run it through a compactor before your waste hauler removes it - compacted waste can be cheaper to dispose of. Once it is out of your facility you don’t have to worry about it - provided nobody finds any problem items or waste that can be traced back to you. If you have done a good job segregating waste you should have no problem.

Types of Waste

Sharps - Sharps is the word used in waste circles to refer to used needles, syringes, lancets, and razors use in medical treatment. Anything that can pierce the skin is a sharp. They are dangerous because they pose an injury risk (laceration) and an infection risk because they expose the body to potentially infectious material. Sharps are a risk for facility personnel, residents, and waste workers. There is an easy answer to sharps risk: containers. You can buy metal or plastic boxes that are designated sharps containers. [INSERT PIC] These can be any color - red or yellow is common - and say Sharps on them. They are not easily punctured. Your medical waste service company empties the boxes periodically. They have ways to treat the sharps to make them less hazardous before disposal. Use sharps boxes and you have this waste stream covered.

Chemotherapy waste - often residents take chemotherapy medication. All pharmaceuticals - but especially chemotherapy agents - pose a hazard to building residents and the environment. Try to return unused medicines to the pharmacy or oncology clinic. If that is not possible, keep pharm waste in a separate waste stream (collection system) and tell your waste disposal contractor. The contractor, if they are experienced in medical waste management, will know what to do and can advise you. Normally you just want to have dedicated containers for pharmaceutical waste - and sometimes chemotherapy waste - and let the management company take it away for you.

Radioactive waste - These types of facilities do not do radiation therapy. The only reason you might run into radioactive waste is if residents are getting radiation therapy elsewhere and their waste comes out on your premises. Brachytherapy (insertion of radioactive pellets into the patient’s body) is fairly common in cancer treatment, and sometimes patients may be given radioactive materials to swallow which end up producing problem urine and feces. Here you have to lean on the medical system that initiated the radiation treatment and follow their procedures for waste management. The best situation for you is if the prescribing doctor’s office agrees to take the waste back from you and if their people transport the waste See our page on radioactive medical waste.

Hazardous waste (RCRA waste) - Under US federal law, waste produced at a business that is reactive, corrosive, flammable, or toxic - is considered hazardous waste. It must be maintained, treated, and disposed of responsibly. The amount of hazardous waste is usually low enough that your facility will be classified as a Small Quantity Generator. The rules are a little easier for small generators, but you must still keep the waste safe until your waste management company picks it up.

Biohazardous waste - Infectious or biological waste should be managed to prevent disease transmission. You don’t normally know what bodily fluids and secretions are infectious. The precautionary principle should be followed:

“When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically.” https://www.sehn.org/precautionary-principle-understanding-science-in-regulation?rq=precautionary/

So plan for the worst. All biological material waste should be considered capable of transmitting disease unless you have reason to believe otherwise. This is why your staff uses gloves and universal precautions. Patients at home are subject to different rules from patients in your facility. If a family member takes bandages off a patient at home, those bandages can go in the normal garbage. If one of your nurse aides takes bandages off a patient in one of your beds, those bandages must be treated as biohazardous waste.

Pathological waste - waste that is recognizable to the human eye as having come from a person is called pathological waste. For sensitivity reasons, it is handled differently. See our page on this type of waste.

Do you have a morgue on site? If so, remember that deceased bodies are not waste in any culture or professional practice. The bodies must be treated with respect. Or even if you don’t have a morgue but have deceased people taken directly from their rooms to a public morgue or funeral home, you need to remember the bodies are not waste. However, the processing of bodies in the morgue may produce fluids or other wastes that should be managed as biohazardous.

Collection and Storage

Establish a waste receptacle system that is consistent through the facility. Establish a collection system for moving waste from smaller containers to larger ones.

Whichever employees are closest to the point of waste generation should put the waste in the correct receptacle.

Facility managers find it useful to establish a color code for waste receptacles. Here is one we recommend:

General, non-hazardous waste (MSW) - black
Bio waste - bright yellow with infectious waste symbol
Pathological waste - red with infectious waste symbol
Pharmaceutical waste - brown
RCRA hazardous waste - any, but not black and preferably different from other categories
Sharps - yellow or red with word SHARPS
Recycling - green with recycle symbol

You should have a room or area for waste storage as it awaits pickup. Municipal solid waste can go into an outdoor container like a dumpster, where a garbage truck can pick it up. Regulated and hazardous waste should be confined in a locked area - probably indoors. You want to make sure no animals can get to this waste and that unauthorized people do not enter. However, you must be able to inspect your containers regularly so be sure there is good lighting. Also, the storage area should be easily accessible to your waste disposal contractor.

Training

Your employees might be great health care providers but that doesn’t mean they automatically know how to handle waste. You need to give new employees training on your waste segregation and collection system and how to classify waste they run into. Further, regular refresher training for staff is highly recommended. And even simple things like signs near waste containers and periodic reminders in memos and facility newsletters can inculcate a culture of responsible waste management.

Recycling

You can cut your waste disposal costs, and earn some brownie points, by establishing a recycling program in your facility. This creates a new waste stream; the material that goes into recycling would have gone into the MSW stream otherwise. So it comes with some administrative costs. Check with your local recycling authority for what they accept. Potential items include:

Fluorescent bulbs, beverage cans (metal) and bottles (plastic), batteries
Paper (office, newspaper), glass, linens
Shipping and packaging materials: pallets, shrink wrap, cardboard, packing peanuts
Computer equipment, ink jet and toner cartridges
Plastic (most types), glass