Best Management Practices For Hospital Waste

1 BestManagementPractices ForHospitalWastePublication Number 05-04-013 October 2005 best Management Practices for Hospital Waste Publication Number 05-04-013 December 2005 If you need this information in an alternate format, please call the Hazardous Waste and Toxics Reduction Program at 360-407-6700. If you are a person with a speech or hearing impairment, call 711, or 800-833-6388 for TTY. Acknowledgements The following individuals contributed in writing, review, technical assistance or consultation during the preparation of the first edition of this guide: Laura Brannen Hospitals for a Healthy Environment Janet Brown Hospitals for a Healthy Environment Cathy Buller Northwest Pollution Prevention Resource Center Dave Enos GeoEngineers/Spokane Aquifer Joint Board Michael Fagan United States Environmental Protection Agency Arianne Fernandez Washington State Department of Ecology Greg Flibbert Washington State Department of Ecology Catherine Galligan Sustainable Hospitals Kenneth Grimm Northwest Pollution Prevention Resource Center Jan Heaton Washington State Department of Ecology Liisa Itkonen Idaho Department of Environmental Quality Dave Johnson Modern Electric/Spokane Aquifer Joint Board Emma Johnson Washington State Department of Ecology Scott Mallery Washington State Department of Ecology Camille Martin Washington State Department of Ecology Chuck Matthews Washington State Department of Ecology Susan McGeorge Whitworth

2 #2/Spokane Aquifer Joint Board Julia McHugh Spokane Aquifer Joint Board Terri Miller Washington State Department of Ecology Peggy Morgan Washington State Department of Ecology Rolfe Parsloe Washington State Department of Ecology Neha Patel Oregon Center for Environmental Health Maria Peeler Washington State Department of Ecology Lori Rodriguez Washington State Department of Ecology Laura Schleyer Washington State Department of Ecology Marni Solheim Washington State Department of Ecology Frank Triplett City of Spokane/Spokane Aquifer Joint Board Dave Waddell King County Department of Natural Resources Ty Wick Spokane County Aquifer Joint Board Jenny Yoo Washington State Department of Ecology Catherine Zimmer MnTAP The research and writing of this publication was cooperatively sponsored by Spokane Aquifer Joint Board and Washington State Department of Ecology, Hazardous Waste and Toxics Reduction Program.

3 Table of Contentsss Chapter 1. Environmental Management Dangerous Waste ..1-1 Getting Started ..1-1 Dangerous Waste Management ..1-4 Air Quality ..1-7 Spills ..1-7 Underground Storage Tanks ..1-7 solid Waste Management ..1-7 Biomedical Waste Management ..1-8 Emergency Planning and Community Right-to-Know Act (EPCRA) ..1-8 Chapter 2. Self Audit Form Hazardous Waste ..2-1 Universal Waste ..2-2 Medical Waste ..2-2 Clean Water/Water Conservation ..2-3 Clean Air Act ..2-5 Federal Insecticides, Fungicide and Rodenticide Act ..2-5 Purchasing ..2-6 Energy Conservation ..2-6 General ..2-7 Mercury ..2-7 Chapter 3. Department-specific pages Administration ..3-1 Autopsy Services ..3-5 Biomedical Engineering Services ..3-7 Central Sterilization Reprocessing and Distribution ..3-9 Clinical Research ..3-11 Construction and Renovation.

4 3-13 Critical Care Services ..3-15 Emergency Care Services ..3-17 Emergency Dental Services ..3-19 Endoscopy Services ..3-21 Food Services ..3-23 Groundskeeping ..3-25 Housekeeping ..3-27 Incineration Services ..3-29 Inpatient Care Services ..3-31 Kidney Dialysis Services ..3-33 Laboratory Testing, Pathology and Histology Services ..3-35 Laundry Services ..3-37 Maintenance ..3-39 Morgue ..3-41 Nuclear Medicine ..3-43 Oncology Services ..3-45 Outpatient Services ..3-47 Pharmacy Services ..3-49 Physical Therapy Services ..3-51 Radiology ..3-53 Respiratory Care ..3-55 Surgery Services ..3-57 Appendix 1. Guidance Documents Appendix 2. Vendor Lists Appendix 3. Resource Web sites Appendix 4. List of Dangerous Waste in Hospitals/Air Pollutants Appendix 5. Biomedical Regulations Appendix 6. Biography Appendix 7. Glossary Introductionnn This guide is a product of the Washington State Department of Ecology (Ecology) best Management Practices (BMPs) for Hospitals Project and financially supported by the Spokane Aquifer Joint Board and Ecology.

5 The project is part of Ecology s Mercury Action Plan to eliminate mercury use in the state of Washington. Goals of Ecology s Mercury Action Plan include: Mercury-free hospitals, Protecting groundwater and drinking water sources, Encouraging implementation of pollution prevention alternatives, Reducing the use of toxic substances and generation of dangerous wastes, Improving dangerous (hazardous) Waste Management Practices , and Increasing regulatory compliance through technical assistance. This guide suggests ideas and steps you can take to manage wastes generated in your Hospital properly. Hospitals can generate large amounts of dangerous (hazardous) wastes. If not managed properly, dangerous Waste can pose threats to your safety, and public safety, and can damage the environment. Proper Management of chemicals and wastes can help prevent serious consequences of catastrophic events or accidents.

6 Your Hospital is most likely already doing some, but not all, of the best Management Practices suggested in this guide. Inside this guide you will find: An introduction to environmental Waste Management concerns in hospitals A Hospital Self-Audit Form to copy and use in each department A page of best Management Practices and information about toxic substance substitution and Waste minimization, for each specific department Other guidance documents, pertinent to Hospital Waste Management A list of pollution prevention vendors A list of resources A list of dangerous wastes often found in hospitals Biomedical regulations A bibliography of publications and resources used to write this publication A glossary of terms and acronyms used in this guide. The information in this guide is not complete and does not address all of the hazards associated with handling chemicals and dangerous Waste .

7 For more information about the hazards of chemicals, contact a chemical manufacturer or supplier, the American Chemical Society, a qualified consultant, or an appropriate government agency. Do not consider information provided about vendors or product suppliers as an endorsement by Ecology. Contact Ecology s Hazardous Waste and Toxics Reduction Program for technical assistance at your nearest regional office. If you have any questions regarding this publication, please contact: Camille Martin (509) 329-3551, or Terri Miller (509) 329-3476. Chapter 1 Environmental Management Dangerous Waste .. 1 Getting Started .. 1 Dangerous Waste Management .. 4 Air Quality .. 7 Spills .. 7 Underground Storage Tanks .. 7 solid Waste Management .. 7 Biomedical Waste Management .. 8 Emergency Planning and Community Right-to-Know Act (EPCRA).

8 8 1-1 Environmental Managementtt This section discusses Ecology s environmental Management concerns in hospitals. The focus of this section is to address proper Management of dangerous Waste in hospitals, but some of the concerns affecting water quality are included in this section as well. There are also brief summaries of other environmental concerns such as solid Waste , air quality, spills, and underground storage tanks. Dangerous Waste (also known as Hazardous Waste ) The Dangerous Waste Regulations, Chapter 173-303 WAC, address designating wastes, generator status, counting your wastes, satellite accumulation requirements, and treating wastes. We encourage your Hospital to keep a copy of the Dangerous Waste Regulations at your facility. You can order a copy by calling (360) 407-6752 or download a copy from For your convenience, the following Ecology publications have been included in Appendix A: Designating Dangerous Waste (Publication # 96-436) Counting Dangerous Waste Under the Dangerous Waste Regulations (#98-414) Satellite Accumulation (#94-120) Treatment by Generator (#96-412) Universal Waste Rule for Dangerous Waste Lamps (#00-04-020) Universal Waste Rule for Batteries and Mercury-Containing Thermostats (98-407) Focus on Pharmaceutical Waste (#03-04-035) Pesticide Container Cleaning and Disposal (#01-04-024) Domestic Sewage Exclusion (#94-136) Wastewater Discharge Permits in Washington State.

9 (#WQ-R-019) Guide for Dangerous Waste Generators in Washington State (#98-1252-HWTR) Getting Started To determine if a Waste is dangerous Waste , you need to know its physical and chemical nature. It is necessary to know all chemical components that make up the specific Waste . Material Safety Data Sheets (MSDS) may tell you something about the properties and constituents of your Waste . Without this type of information, you may have to test each Waste to determine if it is dangerous Waste . The following pages describe a three-step process for Waste designation. You will need a copy of the Dangerous Waste Regulations and Designating Dangerous Waste guidance (located in Appendix A). Step 1 Designate your Waste Take a Waste inventory of your Hospital , in all departments that generate Waste . For each Waste , follow the flow chart in the Designating Dangerous Waste Fact Sheet.

10 This flow chart leads you through a series of questions that will help you decide if your Waste is dangerous. 1-2 Each dangerous Waste has a four-digit Waste number assigned to it. If your Waste meets the definition of a particular type of dangerous Waste , write the four-digit Waste number in the Waste number(s) column of the Waste Inventory Table section of Designating Dangerous Waste . A single container of dangerous Waste may have several different codes. Using the flow chart, write down all of the Waste numbers that apply to each Waste on the Generator Status section of the worksheet. Stop when you reach a box on the flow chart that reads, No further designation is required. Step 2 - Counting your Dangerous Waste Dangerous Waste generators must count their Waste facility-wide each calendar month. Write the dangerous Waste quantities in the Waste Inventory section of the Generator Status Worksheet to determine generator status (small, medium, or large quantity generator).