Healthcare workers manage a number of different forms of hazardous medical waste on a daily basis. Defining what those different categories are can be a real challenge for many. The names alone for the various wastes are difficult to identify, which makes it difficult to recognize, categorize and properly dispose of them.

What are the Hazardous Wastes in Healthcare?

Hazardous medical waste in the healthcare industry fall into a number of different categories:

• Hazardous
• Biohazardous
• Regulated medical
• Red bag
• Universal
• RCRA
• Pharmaceutical
• Chemo
• Pathological
• Isolation
• Infectious
• and more

To begin identifying dangerous medical waste, you have to learn to recognize products that become hazardous when disposed of or are defined as ‘no longer of value.’ The EPA (Environmental Protection Agency) defines a medical product as ‘no longer of value’ if it has expired, when it is no longer going to be used, or thermostats containing mercury. The agency has created four lists which list specific hazardous wastes and four types of hazardous wastes that have defining characteristics:

• U-listed wastes include many pharmaceutical materials which are considered toxic and include chemotherapy wastes, along with other materials such as chemical products used commercially in healthcare facilities
• P-listed wastes are toxic and include a variety of pharmaceuticals and other healthcare materials. Warfarin would fall under the P-listed wastes as it has a concentration of >0.3%.
• F-listed wastes can be found in healthcare facilities or department which includes a maintenance shop or morgue.
• K-listed wastes are typically not part of the healthcare industry.

What Defines Universal Hazardous Waste?

Wastes such as pesticides, equipment containing mercury like the mercury lamps and thermostats or fluorescents are considered universal wastes. Dental amalgam and other radiological wastes like the lead aprons and fixer also fall under universal waste category.

If these types of materials are disposed of in the trash, they will contaminate the environment. They are recyclable and can be handled as universal waste rather than hazardous wastes. This categorization results in fewer restrictions on those who generate these forms of waste. If you are working with a disposal service of your medical waste material, it is important to know this and inform the service, so these materials are disposed of properly.

What are Dual and Mixed Hazardous Wastes?

Dual wastes are those which contain both hazardous and infectious waste. Blood-soaked gauze would be an example of a dual waste when it is also soaked in the chemotherapeutic drug. A used syringe will be another if it contains excess thimerosal preserved vaccines.

Mixed wastes are those which contain both hazardous and radioactive waste components. These mixed wastes have to decay and then be handled as a hazardous waste. When disposing of these materials, the dual and mixed, you have to be working with a disposal service permitted to handle these forms of hazardous medical waste materials.

How to Determine What is Hazardous Waste in Healthcare

A healthcare facility can only be successful with the proper disposal of their hazardous medical waste if they are able to determine which of their materials are hazardous. According to the RCRA (Resource Conservation and Recovery Act) regulations, anyone who generates a waste has to be able to identify whether or not it is hazardous. All healthcare facilities should have a program in place to manage their waste according to the local, city, state, and federal RCRA regulations.

RCRA is the regulations defining hazardous waste according to the EPA guidelines. This act also establishes the management of these hazardous wastes per the EPA on how to manage and adequately treat their disposal.

The easiest method for you to use in identifying medicines that are considered hazardous according to these regulations is to reference the organization’s drug formulary. With this reference, you can classify the drugs based on their NCD number or previous hazard classification. There are some drug packaging which identifies it as hazardous for you as well.

Common Hazardous Materials Found in Healthcare

These are some of the more common hazardous materials you will find in healthcare facilities:

• Pesticides are any substance or a mixture of substances that are intended to prevent or destroy pests. These materials are typically used in healthcare facilities where food is prepared, waste disposal areas, waiting rooms, offices, halls, patient rooms, treatment areas, outside lawns, or other landscaping areas. In the process of eliminating pests, healthcare facilities risk exposing patients, workers, and visitors to toxic chemicals as well as contaminating local water resources. Improper disposal of excess pesticide materials is a violation of Federal Law. These wastes must be disposed of properly through your disposal service.
• Pharmaceuticals
  • can be one of several thousand pharmaceutical materials in your inventory. The same properties that make pharmaceutical hazardous are what make them useful in treatments. Companies spend billions of dollars every year to develop medications that can affect human metabolism at low concentrations. Some of these medicines have to be extremely toxic in order to perform their treatment. The first task is to determine whether a pharmaceutical should be treated as hazardous medical waste. You have to determine which RCRA waste list it falls under such as P-listed, U-listed, or D-listed. You then need to decide whether it is toxic, flammable, corrosive, or reactive. RCRA regulations provide several lists of materials that are automatically categorized as hazardous. You must refer to their guidelines to ensure proper handling and disposing of your pharmaceutical hazardous waste.
• Controlled substance pharmaceuticals 
  • are those that have the potential for dependence or abuse. The CSA divides these drugs into five categories- Schedule I are the drugs that have no medical use, like heroin. Schedule IIis the drugs medically used but have a high potential for being abused like morphine. Schedules III through V are the drugs that have a decreasing potential for abuse and range from sedatives to cough suppressants. Hospitals and clinics can become registered to create a program to accept unwanted controlled substances from patients or the public, to be placed into collection receptacles. These collection receptacles do not change the manner in which the healthcare facility disposes of their hazardous medical waste. The collection receptacles have specific management rules that must be followed and are separate from the healthcare facilities method of disposing of their generated medical waste.
• Laboratory chemicals
  • are used by a number of healthcare facilities and research laboratories. These wastes include chemicals and biological agents that present a hazard to patients, workers, and the public. They can be broadly grouped as:Chemical hazards– corrosive, flammables, toxins, radioactive, and reactive. Biological hazards– animals, plants, microbes, and genetically modified agents.These materials are beneficial in the laboratory but have the ability to cause inadvertent damage to anyone wrongly exposed to them. These hazardous wastes have to be handled and disposed of properly and according to laws governing the disposal of such waste. 
• Sterilants and disinfectants 
  • are essential in healthcare to control infectious organisms. They are vital tools for meeting this need. Sterilants and disinfectants are intended to kill living organisms. What makes them toxic to pathogens can also make them harmful to other organisms. All sterilants and disinfectants are toxic to some degree, but there are some that have a greater killing power than others.Healthcare professionals have developed two classification systems for these materials to help determine appropriate control measures for them. One level classifies levels of infection risk, which means how clean is clean guidelines, and it is based on exposure risks. The other level or system classifies levels of effective potency. The two systems can be used to help you match the material with the need and make sure you maintain a safe level of infection control. Unused disinfectant concentrates must be considered hazardous. They must also be managed under a specific set of RCRA rules. Check the RCRA ‘hazardous waste determination page’ to understand how your sterilants and disinfectants are categorized and how to dispose of them properly. 
• Cleaning chemicals 
  • are vital to healthcare. These materials limit the spread of infection and are used as aesthetic considerations. To ensure the cleaning is done effectively, healthcare facilities use a wide variety of potent chemicals to remove and attack contaminants. Common cleaning chemicals found in the healthcare setting include- dusting aids, air fresheners, glass cleaners, fabric protectants, bathroom and tile cleaners, aerosols for furniture maintenance, and many more. These cleaners benefit the intended areas, but they also have the ability to cause inadvertent damage to people. To check your cleaning chemicals for determining whether or not they are hazardous, see if it is managed under RCRA. You can also choose products that are certified to meet environmental, safety, and health criteria. Several accrediting bodies set guidelines for cleaning products and how they can be environmentally safe. You can find products on the market that are generated under these guidelines, so they do not become hazardous waste.                        

Storing and Disposing of Healthcare Medical Waste

Clinics and hospitals place unused medications in sharp containers for disposal. Employees must be trained on never setting drugs, including hazardous drugs or other hazardous medical waste into these containers or into red bags.   

Hazardous medical waste materials have to be separated into properly labeled containers as they are handled in the disposal system differently. U-listed pharmaceutical waste drugs have to be handled as hazardous, but the package it came in can be placed in the regular trash. P-listed pharmaceuticals like Warfarin has to be handled as hazardous, including the packaging it came in.

Once you have identified your medications as hazardous, they must be placed in a labeled container, usually black, for hazardous drugs. You can use the container for other hazardous medical waste that falls under the same characteristics. Having other labeled containers will help you and all staff members from improperly throwing hazardous wastes into the sharps container, the trash, or in the red bags. Your disposal service should take your hazardous waste materials to a facility permitted to handle these forms of medical waste where they are generally incinerated.