How to plan better for infectious waste disposal

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Along with the safety officer, IPs should have a hand in planning for a pandemic

After reading this article, you will be able to:

  • Explain why it's important to plan for a pandemic with your waste disposal facility
  • Recognize the IP's role in planning
  • List reasons on-site waste disposal technology should be considered

Although the summer months usually override the thought of flu season for healthcare workers and patients, it's these months before the season kicks in that are most crucial for planning.

On June 11, the World Health Organization officially declared a phase six pandemic. Although the organization considers the severity to be moderate, organizations such as the CDC have stressed the importance of planning for the upcoming fall flu season, when the combination of seasonal flu and novel influenza A H1N1 could intensify the effect on healthcare facilities. "Moving forward, we'll have to address two different challenges: seasonal flu, as we have each year, and novel H1N1 influenza," newly appointed CDC director Tom Frieden, MD, said in a June 11 press conference. "We'll be looking at those separately and how they relate to each other."

Although IPs will be focused on employee safety and mitigating the transmission of the disease, one important planning consideration should revolve around disposing of an increase in infectious waste during a pandemic. IPs' involvement in pandemic planning and knowledge of the flu?s infectious properties mean their input is vital.

Unfortunately, it's often an issue that is put on the back burner, says Alice Jacobsohn, director of the Medical Waste Institute, a subgroup of the National Solid Waste Management Association. "It's very hard to get people to focus on it," Jacobsohn says. "And to some degree, it's understandable. You are more concerned with human life than what to do with the waste on the back end. Obviously, protecting the public health is more critical in terms of planning."

But failing to consider disposal options for excess infectious waste could lead to risky situations. In a May 18 op-ed article for The Washington Times, Darrell Henry, executive director of the Healthcare Waste and Emergency Preparedness Coalition, wrote that facilities that do not plan for infectious waste disposal could put public health at risk. "Ninety percent of our hospitals since the mid-1990s have chosen to export their infectious waste through their local communities and over our roads and highways," Henry wrote. "However, during a pandemic, infectious waste should not be allowed to leave the realm of the clinical experts on disease control at our nation's hospitals."

Although not all hospitals have the option for on-site disposal systems, every medical facility should plan for what to do with an excess of infectious waste.


Contacting your hauler

The primary concern in building a pandemic waste disposal plan is the amount that is being generated, but that amount is difficult to predict, and the pandemic planning team usually ends up making an educated guess. Fortunately, waste disposal facilities are used to handling infectious waste on a daily basis, so the challenge is determining how much will exceed their limits.

"The infectious substance itself is not unusual in the sense of what medical waste disposal companies handle every day," Jacobsohn says. "And there are certainly other diseases out there that are far worse than flu-type treatments. So in terms of the materials itself, there's expertise out there in terms of dealing with this, so you don't have a sort of 'Gosh, what do we do with this?' approach."

To be fully prepared to handle an increase in waste, the No. 1 initiative for hospitals is to contact their waste hauler and work out the details should a pandemic arise. Because pandemic prevention has so much to do with mitigating the spread of disease, the IP should be a part of this planning call. (See 'Questions for your waste hauler' below.)

Considering on-site options

In his editorial, Henry pointed out that modern technology allows facilities to sterilize or autoclave infectious waste on-site, reducing the amount transported and decreasing risk to the public. "With real threats of pandemics, transporting infectious and contagious medical waste is no longer prudent," he wrote. "Modern, affordable technologies can cleanly, safely, and economically sterilize infectious and contagious waste on the premises of healthcare facilities. Treating hazardous materials on-site is also a cleaner, greener, less costly, and, most important, safer option."

Jacobsohn says on-site disposal or sterilization is a valid option, but facilities should be wary of treatments that falsely claim to sterilize the waste—these may reduce the risk but will not eliminate it. She says each facility should look at its current equipment, determine how much extra waste it can handle, and coordinate with the waste hauler.


Finding storage

A final consideration is figuring out where your healthcare facility will store its excess waste. Jacobsohn notes that most hospitals do not have extra storage space for waste containers.

For example, if your facility normally produces 5 lb. of waste each day and fills up one container, a pandemic could mean it produces 10 or 20 times more and would require additional containers.

"Most hospitals don't have the kind of storage that you could keep that many additional containers in a closet somewhere," Jacobsohn says. Thus, the hospital needs to coordinate a plan with the waste hauler to get extra containers quickly.

Another part of the waste problem is that some disposal facilities are not equipped to handle an increase in loads. If your hospital has a contract with the hauler, make sure it stipulates that the disposal facility can handle the spike in waste. If it cannot, speak with other facilities about handling additional waste or consider employing on-site disposal methods.