Hazardous Drug Waste Disposal Requirements
Does your facility handle hazardous drugs? If so, do your hazardous drug safety guidelines include proper waste disposal procedures?
Hazardous drugs are often prepared and administered to human and animal patients in hospitals, outpatient centers, physician’s offices, veterinary hospitals and veterinary clinics. When hazardous drugs are discussed, chemotherapeutic drugs often come to mind, but hazardous drugs also include certain antibiotics and antivirals such as Ribavirin, an antiviral against respiratory syncytial virus (RSV), and Pentamidine, used in the treatment and prophylaxis of pneumonia.
A drug is considered hazardous if it poses any or all of the following health risks against humans:
- Genotoxicity, damaging to genetic material;
- Carcinogenicity, cancer producing;
- Teratogenicity (developmental malformations) or fertility impairment; and
- Serious organ or other toxicity at low doses.
These drugs are considered hazardous because they are cytotoxic--they mutate or kill cells. They disrupt cell division and kill actively growing cells, and cannot distinguish between normal or diseased cells.
Risks to personnel working with HD's are a function of the drugs' inherent toxicity and the extent of exposure. The main routes of exposure are: inhalation of dusts or aerosols, dermal absorption, and ingestion. Contact with contaminated food or cigarettes represents the primary means of ingestion. Opportunity for exposure to HD's may occur at many points in the handling of these drugs.
According to OSHA, “Contaminated materials used in the preparation and administration of HD's, such as gloves, gowns, syringes and vials, present a hazard to support and housekeeping staff. The use of properly labeled, sealed and covered disposal containers, handled by trained and protected personnel, should be routine. Drugs that are unused commercial chemical products and are considered by the EPA to be toxic wastes must be disposed of in accordance with 40 CFR part 261.”
OSHA and NIOSH have specific guidance in place for the disposal of these drugs. The following information was gathered from OSHA and NIOSH sources.
1. The first step in safe drug handling is to identify those drugs recognized as being hazardous. A partial list is available at the following link:
2. Be aware of the various types of waste generated by preparing and administering hazardous drugs, including partially filled vials, undispensed products, unused IVs, needles and syringes, gloves, gowns, underpads, and contaminated materials from spill cleanups.
3. Place trace wastes (those that contain less than 3% by weight of the original quantity of hazardous drugs)—such as needles, empty vials and syringes, gloves, gowns, and tubing—in yellow chemotherapy waste containers, for disposal at a regulated medical waste facility. Needles, syringes, and breakable items such as vials, not contaminated with blood or other potentially infectious materials, should be placed in a yellow "sharps" container before they are stored in the waste bag.
Do not place hazardous drug-contaminated sharps in red sharps containers that are used for infectious wastes, since these are often autoclaved or microwaved [ASHP 1990; OSHA 1999; Smith 2002].
4. In addition to standard pharmacy labeling practices, all syringes and IV bags containing HDs should be labeled with a distinctive warning label, such as:
SPECIAL HANDLING/DISPOSAL PRECAUTIONS
5. Gross contaminated waste (>3% by weight of the original quantity of HD), including expired or unused vials, ampules, syringes, bags or bottles of HD or solutions of any other items should be returned to the pharmacy for disposal in a designated chemotherapy container. Partially used vials, ampules syringes, bags etc of HD that are P or U listed must be picked up at or near the point of administration.
6. When packaging HDs for transport, the outside of bags or bottles containing the prepared drug should be wiped with moist gauze. Entry ports should be wiped with moist alcohol pads and capped. Chemotherapy gloves and protective clothing should be worn, and hands should be washed with soap and water afterwards.
7. Transport of all hazardous waste should occur in yellow sealed, thick, leak-proof plastic bags and in containers designed to avoid breakage. The waste bag should be kept inside a covered waste container clearly labeled "HD WASTE ONLY." At least one such receptacle should be located in every area where the drugs are prepared or administered. Waste should not be moved from one area to another. The bag should be sealed when filled and the covered waste container taped.
Assuring that drug-contaminated waste is properly contained will protect workers from respiratory exposure to volatile or micro-aerosolized drugs.
Prudent practice dictates that every precaution be taken to prevent contamination of the exterior of the container. Personnel disposing of HD waste should wear gowns and protective gloves when handling waste containers with contaminated exteriors. Prudent practice further dictates that such a container with a contaminated exterior be placed in a second container in a manner that eliminates contamination of the second container.
Hazardous drug-related wastes should be handled separately from other hospital trash and disposed of in accordance with applicable EPA, state, and local regulations for hazardous waste. This disposal can occur at either an incinerator or a licensed sanitary landfill for toxic wastes, as appropriate. A licensed company must perform commercial waste disposal. While awaiting removal, the waste should be held in a secure area in covered, labeled drums with plastic liners.
If hazardous drugs are used in your facility, a program for safely handling should be implemented and reviewed annually on the basis of the workplace evaluation. These policies and procedures should address and define the presence of hazardous drugs, labeling, storage, personnel issues (such as exposure of pregnant workers), spill control, and procedures for preparing, administering, and disposing of hazardous drugs. Training on drug handling should be performed regularly with potentially exposed workers.