Regulated Medical Waste Management Training

1. Green Environmental Management System Regulated Medical Waste Management Training Prepared In Accordance with: Massachusetts Department of Public Health Requirements for Medical/Biological Waste and Department of Transportation Hazardous Materials Regulations March 2014

2. Green Environmental Management System Training Objectives Attendees should understand: How to label and manage containers of regulated medical waste on campus; State-specific requirements for areas where these wastes are stored; How to prepare packages for shipment, and Proper management of shipping papers and the record keeping log

3. Green Environmental Management System What is Regulated Medical Waste? In Massachusetts, regulated medical waste is governed by the Department of Public Health (DPH) regulation 105 CRM 480,”Minimum Requirements for Biological Waste”

4. Green Environmental Management System What is Regulated Medical Waste? • The DPH defines medical or biological waste as: "Waste that because of its characteristics may cause, or significantly contribute to, an increase in morlalityor an increase in serious irreversible or incapacitating reversible illness; or pose a substantial present potential hazard to human health or the environment when improperly treated, stored, transporled, disposed of, or otherwise managed."

5. Green Environmental Management System Types of Regulated Medical Waste The following types of medical or biological waste are routinely generated by VAMC operations: Blood and blood products: Discarded bulk human blood and blood products in free draining, liquid state; body fluids contaminated with visible blood; and materials saturated/dripping with blood. Sharps: Discarded medical articles that may cause puncture or cuts, including but not limited to all, used and discarded hypodermic needles and syringes, Pasteur pipettes, broken medical glassware, scalpel blades, disposable razors, and suture needles.

6. Green Environmental Management System Packaging for Regulated Medical Waste A red, fluorescent orange, or orange- red plastic bag is authorized as the primary packaging for all medical or biological waste except sharps. The bag and the container that it is stored in must be prominently marked with the universal biohazard warning symbol and the word "BIOHAZARD" in a contrasting color

7. Green Environmental Management System Packaging for Regulated Medical Waste The plastic film bag must be closed with a minimum of entrapped air and secured so as to prevent leakage, or loss of contents during handling, storage, and transport.

8. Green Environmental Management System Packaging for Regulated Medical Waste Sharps must be segregated and stored in a puncture-resistant inner packaging (sharps container). The container must be red, fluorescent orange, or orange-red and prominently marked with the universal biohazard warning symbol and the word "BIOHAZARD" in a contrasting color.

9. Green Environmental Management System Handling and Storage All areas used for storage of regulated medical waste must: Be in an uncarpeted room or area with impervious, cleanable, non-absorbent flooring; Have prominent signage indicating that space is used for the storage of bio hazardous waste; Be designed or secured to prevent unauthorized access;   Provide sufficient space for clear separation of bio hazardous waste from other wastes; and maintained such that there is no putrescence or odors

10. Green Environmental Management System Shipment of Regulated Medical Waste Transportation of wastes off campus is regulated at both the state and federal levels by the DPH and the Department of Transportation (DOT). In addition, your vendor Stericycle has its own specific requirements for packaging and shipping documentation.

11. Green Environmental Management System DOT Shipping Requirements The DOT Hazardous Materials Regulations apply: To all shipments of hazardous materials "in commerce"; and When the hazardous materials are being prepared for shipment VAMC employees who perform the following duties are considered hazardous materials "Hazmat" employees and must receive training every 3 years: Prepares packages of regulated medical waste for shipment; or   Signs Stericycle shipping papers.

12. Green Environmental Management System DOT Hazmat Employee Training Requirements The training must include the following elements: General awareness of the regulations;   Function specific training applicable to the employee's responsibilities; Safety training; and Security awareness training.

13. Green Environmental Management System Overview of the Hazardous Materials Regulations

14. Green Environmental Management System What is Regulated? Hazardous materials are: Materials in commerce that pose a potential risk to health, safety, property or the environment; and Are identified in the Hazardous Materials Table or are otherwise classified by the regulations . All hazardous materials being offered for shipment

15. Green Environmental Management System Hazardous Materials Table Proper DOT shipping descriptions are found using the Hazardous Materials Table. This is an alphabetical listing of all regulated hazardous materials and is a useful summary of the DOT regulations pertaining to a specific shipping name. 49 C.F.R. § 172.101. Available online at: http://phmsa.dot.gov/hazmat/regs

16. Green Environmental Management System Hazardous Materials Table

17. Green Environmental Management System Selecting Shipping Descriptions Shippers are required to select the most specific shipping name possible. The proper shipping description for DOT consists of the: ID number proper shipping name, numerical hazard class or division number, and packing group. Columns 4, 2, 3, and 5 of the Hazardous Materials Table respectively For example: UN3291, Regulated Medical Waste, n.o.s., 6.2, II

18. Green Environmental Management System ID No., Hazard Classes, and Packing Groups UN or NA identification number is unique 4 digit numeric designation. Hazard Class or Division identifies the type of hazard posed by the material. There are 9 hazard classes and some of them include divisions. All hazardous materials are assigned to a hazard class. Packing Group (I, II, and III) indicates the degree of the hazard within a hazard class, I being the greatest, and III the least

19. Green Environmental Management System DOT Hazard Classes

20. Green Environmental Management System Class 6 - Poisonous/Infectious Substances Division 6.2: (infectious substance) means a material known to contain or suspected of containing a pathogen. A pathogen is a micro-organism (including bacteria, viruses, rickettsiae, parasites, fungi) or other agent such that can cause disease in humans or animals. Regulated Medical Waste is always categorized as a Division 6.2 Infectious Substance in Packing Group II

21. Green Environmental Management System Packaging for Regulated Medical Waste Inner containers such as plastic film bags and sharps containers must be contained in a rigid outer packaging such as a fiberboard box and clearly marked with the words "BIOHAZARD," and "Regulated Medical Waste, n.o.s., UN3291."

22. Green Environmental Management System Packaging for Regulated Medical Waste Line the box or container with a red biohazard bag. The bag should be folded down to overlap the outside of the box and hold the flaps against the 4 sides of the box. Dispose of only medical waste in the red bag.   DON'T place medications, loose needles or other sharps, trash, recycling, trace chemotherapy, or pathological waste in the red medical waste bag. Do not overfill the container. Leave space at the top so that it can be easily closed. The completed package must weigh less than 55 pounds.

23. Green Environmental Management System Packaging for Regulated Medical Waste Gather, twist, and tie the red bag. While wearing gloves, gather the 4 edges of the red bag from the sides of the container. Twist the top of the bag to seal its contents. Secure the seal with a strong, hand-tied single or gooseneck knot to prevent any leakage if inverted. You can also use a zip tie or tape to secure the knot. Ensure that the bag is completely closed. Seal your medical waste container. For corrugated boxes, seal the top of the box with the 2-inch wide, clear packing tape. For auto-locking boxes, engage the top flaps. For reusable container, secure the lid, and engage all closures and locking

24. Green Environmental Management System Packaging for Regulated Medical Waste Verify all container markings. The word "BIOHAZARD" and the BIOHAZ symbol "Regulated Medical Waste, n.o.s. UN3291." Directional arrows ADD(DIRECTIONAL ARROWS,UP) Be alert to potential security risks. Keep regulated medical waste storage areas locked or otherwise secured; Never leave regulated medical waste unattended or outside the building; and As necessary, question suspicious/unfamiliar persons about their presence in these areas.

25. Green Environmental Management System Shipping Papers and the Medical/BiologicalWaste Record Keeping Log

26. Green Environmental Management System DOT Shipping Paper Requirements Unless specifically exempted, all hazardous materials shipments must be accompanied by shipping papers Shipping papers may be in any form provided they include all the specific information required by the DOT hazardous materials regulations.

27. Green Environmental Management System DOT Shipping Paper Requirements Shipping papers must include: An indication of whether it is a hazardous material (HM); Proper shipping name; Hazard class or division; Identification number; Packing group; Number and type of packages Total quantity and units; 24-hour emergency response telephone number; and Shipper's certification (signature), that the materials are being properly offered in compliance with HMR

28. Green Environmental Management System Medical Waste Tracking Form ADD DOT form Generator Information Transporter Information Destination Facility Proper Shipping Name Total Quantity Emergency Response Telephone Number Authorized Signature

29. Green Environmental Management System Shipping Paper Maintenance • Maintain the original copy of the shipping paper that you have signed and submit it to your supervisor. • The VAMC must ensure that a return copy of the shipping paper signed by the designated facility is received within 30 days of the shipment leaving campus. • The original and the signed copy from the destination facility should be stapled together and maintained in Section 5 of the record-keeping log for a minimum of two Years.

30. Green Environmental Management System

31. Green Environmental Management System Medical/Biological Waste Record Keeping Log • In addition to the shipping papers, the VAMC is required to document each individual shipment on the record keeping forms provided by the DPH. • These can be found in Section 3 of the record-keeping log and must be maintained for a minimum of three years.

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