BUMEDINST 6280 1 Mgmt of Reg Waste HM1 WD

BUMEDINST 6280.1 MANAGEMENT OF REGULATED MEDICAL WASTE

HM1 Enlisted Advancement ProgramBy HM1(SCW/FMF) Williford Dagher, Jessica

Management of Regulated Medical Waste

• Purpose• To provide standards for management of regulated medical waste

(RMW) (used interchangeably with infectious waste) at Navy shore medical treatment facilities (MTFs) and dental treatment facilities (DTFs).

• Pharmaceutical wastes have additional considerations and shall be managed per reference (a).

• Reference (b) provides guidelines that Navy Shore MTFs and DTFs will

• incorporate to protect medical personal from occupational exposures to blood or other potentially

• infectious material.

BUMEDINST 6280.1B

• Background

• Concern about potential adverse environmental and public health effects of RMW noticeably increased after isolated incidents of improper disposal gained widespread media attention in late I980s to 1990s.

In this presentation regulated medical waste is classified as either non- RMW or RMW.

∙Non-RMW is solid material intended for disposal, produced as the direct result of patient diagnosis, treatment, therapy, or medical research. It requires no further treatment and disposed in general trash. (Ex: soiled dressings, bandages containing very small amounts of blood or other body fluids, disposable catheters, swabs, used disposable drapes, gowns, masks, and empty used specimen containers/urine cups)


∙RMW is generated during diagnosis, treatment, or immunization of humans or animals - is capable of causing disease or would pose other adverse health risks to individuals or the community if improperly handled

There are 9 groups of RMW-Based on associated risks and handling, treatment and disposal requirements provided in enclosure:

1. Cultures, Stocks, and Vaccines, 2. Pathological Waste, 3. Blood and Blood Products, 4 & 7. Sharps, 5. Animal Waste (when exposed to infectious agents during research, production of biologicals, or testing of pharmaceuticals). 6. Isolation Wastes, 8. Other (including fluids designated by the local infection control authority), 9. Chemotherapy Trace Wastes.

Pharmaceutical Wastes

• Pharmaceutical wastes have separate requirements and shall be managed per the “Navy Environmental Health Center Pharmaceutical Waste Management Guidelines.”

BUMEDINST 6280.1B• Collection/ Segregation:• RMW shall be placed in containers, bags, or sharps containers (as

appropriate for the waste) that are either labeled with universal biohazard symbol and the word “BIOHAZARD” or red in color.

• Lining containers-• with plastic bags of sufficient thickness (typically 3 mm) so a single bag will

be enough for most situations, durability, puncture resistance, and burst strength to prevent rupture or leaks.

• Disposal of Sharps-• used and unused waste, discarded vaccines/vaccine containers in rigid,

puncture resistant sharps containers. Never clip, cut, bend or recap needles. Close container to prevent spillage or protrusion of contents.

• Do not overload bags or sharps containers.


• Packaging and Handling• Place Sharps containers in a second container (plastic bag or rigid

box) labeled and/or color coded before treatment and disposal. (Do not transport RMW in chutes or dumbwaiters)

• Anatomical pathology waste: in double-wall corrugated boxes or equivalent rigid containers that are double-lined with plastic bags for transport and incineration in an infectious waste incinerator.

BUMEDINST 6280.1B• Storage

• Store RMW (excluding pathological waste) in RMW storage areas not to exceed 7 days.

• Pathological wastes must be refrigerated or frozen in dedicated cold storage units.

• RMW storage areas- Shall be easily cleanable, prevent past access, Main entrance shall have a “RMW” and

a Universal Biohazard Sign and any additional warnings or instructions necessary for a safe environment. Pathological Wastes- Must be refrigerated and then frozen if stored more then 24 hours (not to exceed 30 days).


• Storage

• Rules & Laws related:

• Regulated Medical Waste must not exceed storage contracts. Any Local, State or country rules & regulations that exist should be followed and if more stringent supersede them.

BUMEDINST 6280.1B• Transportation

• If transporting off site- • Place in rigid, leak-proof containers prior to transporting

off-site. (labeled or color coded).• Comply with Federal, State & Local Laws, Regulations or

Status of Forces Agreements (i.e. licensing & vehicle labeling).


• Treatment & Disposal

• Treatment of RMW is done through:• Incineration or• Inactivation by heat, chemicals or radiation.

• If absence of Federal Regs- comply with State & Local regulations.

BUMEDINST 6280.1B• Groups 1-9

• Group 1: Cultures, Stocks & Vaccines include infectious agents, cultures from lab and culture dishes, d/c’d live & attenuated vaccines. Microbiologic waste should be separate from general waste for decontamination. Liquid waste may be sterilized & disposed in sewage system or kept in original container and placed in sharps container. Vaccines: Unused vaccine should be given to pharmacy for return. Nasal mist disposed in non sharps RMW . -Dental procedure carpules with blood or broken d/c’d in Sharps. Carpules otherwise are disposed regular.


• Group 2: Pathological Waste include human tissue, organs, body parts, teeth or body fluids removed during surgery, autopsy or other procedures. Dispose in a RMW container lined with a plastic bag or double bag with RMW bags

BUMEDINST 6280.1B• Group 3: Blood and Blood Products to include free-

flowing human blood, plasma, serum and other blood products, absorbent materials soaked or dripping with blood or items caked with dried blood.

• Disposal: Bulk blood may be disposed in sewer unless specified otherwise by local, State or host nation laws.

• Breakable containers of blood product- Rigid container• Blood products, blood bags & tubing (remove needles

avoiding unsafe manipulation)- RMW bags


• Groups 4 and 7: Sharps such as when used in human or animal care, medical research treatment or laboratories

• Includes: Needles, syringe (with or without needle), Pasteur pipettes, scalpel blades, blood collection tubes & vials, needles attached to tubing, culture dish (regardless of presence of infectious agents), included broken or unbroken glass in contact with infectious agents (i.e. slides and coverstrips),

• -Do not break, bend or re-cap needles using a two-hand method

• Group 4: Used• Group 7: Unused

BUMEDINST 6280.1B• Installation and replacing Sharps containers:

• Wall mounted sharps containers will be at a height that promotes safe usage by staff.

• Remove and seal sharps containers when ¾ full or above fill line.


• Group 5: Animal Waste

Included: Animal carcass, body parts & bedding known to be exposed to infectious agents during research, biological production or pharmaceutical testing. (Managed through RMW or incineration)Excluded: Roadkill Carcass, euthanized animals, animals dying of natural causes and waste produced by Veternary practices

BUMEDINST 6280.1B• Group 6: Isolation Wastes includes bedding from human or animals

infected with BSL Level 4 agents.

• Included: biological wastes and discarded materials contaminated with blood, excretion exudates or secretions from humans or animals isolated from others with highly communicable disease

• Note: Follow facility Infection Control (IC) Directives and/or the IC Committee on handling isolation waste, particularly with BSL Level 4 agents

Management of Regulated Medical Waste• Group 8: Other• Includes: Fluids designated as RMW by local infection control.

Cerebrospinal fluid, Semen, Vaginal secretions, Synovial, Amniotic, peritoneal or pericardial fluids

• Items dripping or saturated with infectious agents should be placed in RMW bags.

• Consult the facility IC Directives and/or the IC Committee on handling RMW fluids

BUMEDINST 6280.1B• Group 9: Chemotherapy Trace Wastes• Includes: needles, empty vials, and syringes, gowns, and tubing

containing chemotherapeutic pharmaceuticals or were exposed to chemotherapeutic pharmaceuticals during treatment of the patients.

• Note: Do not mix trace chemotherapy waste with non-chemotherapy RMW or Haz. Waste.

• Disposal: Normally yellow provided by a medical waste disposal contrator.

• (Consult the facility chemotherapy drugs protocol or contact• the IC Committee and/or Safety Office for additional guidance)

Management of Regulated Medical Waste• Manifesting and Recordkeeping• Each MTF/DTF must develop and document a system to monitor

disposal of RMW per local, State, and Federal regulations.

• Shipping: Federal regulations require facilities maintain shipping paperwork/manifests for 2 years after the RMW was accepted by the waste carrier. State regulations may be stricter.

• Information needed for tracking in the facility:• Date• Type of Waste• Amount (weight, volume, or number of containers)• & Disposition

BUMEDINST 6280.1B• Training• All employees with occupational exposure to RMW

receive training prior to beginning work and at least annually thereafter. Supplemental training is given with any updates related to RMW.


• Cleanup of Spills• Post staff to prevent personal from entering the area.

• Wear appropriate personal protective equipment (PPE) to prevent exposure to RMW during clean up including required levels of:

• Gloves, • Coveralls, • Masks, and • Goggles

• Remove blood and body fluid spills with an absorbent material and disinfect the area with an EPA-approved disinfectant or a solution of household bleach 1:10 dilution with clear water

BUMEDINST 6280.1B• Medical Waste Disposal and Treatment Methods

• Steam sterilization requires temperatures of at least 121° C (250° F) for at least 90 minutes at15 pounds

• per square inch of gauge pressure to be effective.

• Geobacillus stearothermophilus spore strips must be• used weekly to test the sterilization process.


BUMEDINST 6280.1: Management of Regulated Medical Waste

References

• BUMED INSTRUCTION 6280.IB

• Navy Environmental Health Center Pharmaceutical Waste Management Guidelines

• 29 CFR 1910.1030, Occupational Exposure to Bloodborne Pathogens

BUMEDINST 6280.1: Management of Regulated Medical Waste

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BUMEDINST 6280 1 Mgmt of Reg Waste HM1 WD