Throwing It All Away: The Hidden Hazards of Medical Waste Disposal

Sam and Sally have lived in their cozy home together for their entire 50-year marriage. Sam has diabetes and takes insulin, and Sally has breathing problems from a condition known as COPD. Sally also has poor blood flow in her legs which has recently caused a wound to form on her ankle. The nurse visits daily to assess Sally’s ankle wound and change the dressing.

Today is the day for their regular home trash pickup, and Sam and Sally ask you to help them collect their trash and take it to the end of the driveway. As you move through the home collecting trash from individual trashcans, you notice there are a few of Sam’s used insulin needles mixed in with the kitchen trash, and Sally’s tissues that she has used to cough up sputum lying on her bedside table.

You also notice an empty red biohazard bag that the nurse left behind in Sally’s bedroom, and a full red sharps container in the laundry room.

While you are collecting their trash, Sam calls out to you to say Sally’s dressing has fallen off and he isn’t sure what to do with it. He also adds that they have some expired medications that were left over from a surgery years ago and they’d like to flush them down the toilet.

You remember being taught about the proper disposal of contaminated items during your orientation, but for the moment you aren’t really sure which trash needs to be in a puncture-proof sharps container, in a red biohazard bag or medical waste box, flushed down the toilet, or just thrown in with the regular household garbage.

You wonder:

• Do you need to wear gloves to collect the trash?
• Are you allowed to pick up Sally’s used tissues? Where should they go?
• Should you retrieve Sally’s dressing that fell off? Where should it go?
• Should you retrieve the used insulin needles from the kitchen garbage?
• Should you take the full sharps container back to the home office with you when you leave or put it into the household garbage?
• Should you put everything in the empty red biohazard bag?
• Should you tell Sam to go ahead and flush the expired medications?

What is Medical Waste?

The Environmental Protection Agency, or EPA, and the Occupational Safety and Health Administration, or OSHA, identify medical waste as healthcare waste that is potentially contaminated by blood, body fluids, and other potentially infectious materials, commonly abbreviated OPIM. It is also called regulated medical waste.

Who Regulates Medical Waste?

Medical waste management is primarily regulated by state health and environmental departments as well as federal agencies such as the:

• Centers for Disease Control, or CDC
• Occupational and Health Administration, or OSHA
• Food and Drug Administration, or FDA

Medical Waste in the Home

All medical waste has the potential to carry the human immunodeficiency virus, or HIV, the hepatitis B or C viruses, and other transmittable infectious agents.

Examples of medical waste that you might encounter in the home include discarded:

• Bandages and dressings soiled with blood and/or body fluids
• Used gloves and other PPE
• Needles
• Lancets and glucose strips
• Sharps containers
• Urinary catheter sets
• Intravenous, or IV catheters
• Cotton swabs used for wound care
• Tongue depressors
• Tissues with sputum or other body fluids
• Filled biohazard bags
• Specimen containers and bags, such as lab vials

Your Responsibility With Medical Waste

It is your responsibility to be aware of which items in the home are considered medical waste and know how to properly dispose of them. All medical waste must be safely:

• Segregated
• Handled
• Labeled
• Stored
• Disposed of

Your role is to safely contain and discard sharps and other medical waste as well as know where to find additional resources. This is important not only for your own protection, but for the protection of the individuals you work with, those you care for, and the community outside of the home.

Handling and Disposing Medical Waste

OSHA requires that your organization have a written policy and procedure program that eliminates or minimizes your risk for exposure to blood and other potentially infectious materials.

Be sure you are familiar with your organization’s program, called the Exposure Control Plan.

Containers for Medical Waste

State laws and local ordinances will designate the regulations for disposal of medical waste. There are additional regulations put forth by OSHA that specify the characteristics of all containers for medical waste. Regulated waste containers must be:

• Closable
• Constructed in such a manner that all contents are contained with no leakage during handling, storage, transport, or shipping
• Labeled or color-coded according to accepted standards
• Closed to prevent spillage or protrusion of contents during handling, storage, transport, or shipping
• Placed in a second container that meets the listed standards if the outside of the container is contaminated

Visiting surveyors who are assessing medical waste handling and disposal will be looking for evidence that demonstrates:

• Policies and procedures govern your practice.
• Adequate supplies are available for you to use to handle medical waste appropriately.
• Proper training is provided initially and annually.
• Approved procedures exist for handling and disposing of medical waste.
• Documentation of education being provided for individuals and their families regarding medical waste.

You need to be mindful of the need to educate individuals and their families about the correct procedure for handling and disposing of medical waste.

They must receive instruction in a manner and language they understand, and your organization must have documentation in place to show instruction has been provided.

What Your Practice Can Do About Medical Waste

Now that you have learned a few specifics that guide medical waste handling and disposal, there are practices that you can incorporate into your care given in the home. They are:

• Be aware of and abide by all organizational policies and procedures.
• Follow standard precautions at all times including hand hygiene and the use of PPE.
• Ensure sharps are placed in an approved sharps container immediately after use.
• Keep sharps containers upright and close to the individual during use of the sharp.
• Close the sharps container top when not in use.
• Avoid the overfilling of sharps containers and replace sharps containers appropriately.
• Dispose of used sharps containers per organizational and community guidelines.
• If outside contamination of the primary medical waste container occurs, place it in a second approved medical waste container.
• Follow organizational, local, state, and federal regulations for disposal of all regulated medical waste, including medications and contaminated PPE.
• Educate individuals and their families about the proper handling and disposal of medical waste and document all instruction per organizational policy.

One of the many challenges of working in a home-based environment is determining how to properly identify and manage medical waste.

You must be able to recognize regulations that govern medical waste disposal in the home, as well as implement the proper procedure for the handling and disposal of contaminated sharps, medications, and other regulated medical waste.