Managing Hazardous Waste and Materials - P2 InfoHouse · gram for managing hazardous materials and wastes, which is described in JCAH standards. The hazardous materials and wastes

- n * 1

Plant, Technology, and Safety ~~~~<~~ Management Series

Monograph Managing Hazardous Wmtes and Materials

Copyright 0 1986 by the Joint Commission on Accreditation of Hospitals 875 North Michigan Avenue Chicago, Illinois 606 11

ISBN: 0-86688-097-6

Acknowledgments

Authors

Allan McLean Staff Engineer Department of Plant and Technology Management JCAH Chicago, Illinois

Ronald Lehmann Senior Editor Department of Publications JCAH

Contents

Introduction

Chapter 1. Waste Disposal: A Historical Perspective

Chapter 2. Types of Hazardous Wastes and Methods for Handling

Chapter 3. Hazardous Materials and Wastes in Specific Service Areas

Chapter 4. Identifying and Storing Hazardous Materials and Wastes

Chapter 5. Options for Waste Disposal

Chapter 6. Ways To Reduce the Hazards of Hazardous Materials and Wastes

Chapter 7. Methods for Monitoring Hazardous Gases and Vapors

Chapter 8. Hazardous Materials and Wastes Program: Documentation

Chapter 9. Developing an Emergency Response Plan

Chapter 10. New Federal Regulations Concerning Hazardous Materials and Wastes

Bibliography

Appendix A. JCAH Standards on the Management of Hazardous Materials and Wastes

Appendix B. Sample Material Safety Data Sheets

7

9 11

17

21

23

27

29

3 1

33

37

39

41

59

Introduction

Infectious wastes, radioactive wastes, chemotherapeutic wastes, laboratory chemicals, and even disposable syringes are among the many hazardous materials and wastes that require careful management in the increasingly complex physical environment of hospitals and other health care facilities. These facilities, along with nearly all other industrial organizations in our technological era, are subject to mounting public and political concern about their methods of handling and disposing of hazardous materials and wastes. Pressure has never been greater to establish a process for managing these materials from the time they are received by or produced in a health care facility to the time they are disposed of.

Ironically, the combined forces of public opinion and legislation have done much to impede development of an effective management process. New legis- lative measures are frequently sparked by major events that focus public opinion on specific problems associated with hazardous materials and wastes. As a result, regulations are developed and placed in effect by a variety of governmental bodies (eg, the Occupational Safety and Health Administration, the Environmental Protection Agency, and state and local authorities) with no central guidance for keeping each new set of rules consistent with all the others. Thus, the regulations often confict. They are not only largely unen- forceable but also of little direct assistance to organizations attempting to design a practical system for handling hazardous materials and wastes.

JCAH’s plant, technology, and safety management (PTSM) standards approach the problem of hazardous materials and wastes by specifying principles for developing an effective process for managing such materials. The standards do not address hazardous materials from a highly technical standpoint. Tech- nological problems are the province of regulatory agencies rather than agencies such as JCAH, which accredits facilities on the basis of their system for assuring quality of organizational performance rather thzn ofi the basis of exhaustive technical issues involved in performance itself. The PTSM standards at- tempt instead to provide a framework for evaluating the effectiveness of the regulatory agencies’ principles for handling hazardous materials and wastes and offer suggestions for making progressive adjustments where methods described by regulatory agencies are found to be ineffective.

This monograph approaches the problem of managing hazardous materials and wastes with the same flexible outlook as the PTSM standards. Guidelines for establishing a management process are empha-

sized, with due recognition that as a facility’s knowledge of its own unique problems evolves, its system for handling hazardous materials and wastes will be continuously revised. Where this publication makes reference to technological issues, simple examples are provided. Such descriptive references are always meant to illustrate some aspect of a dynamic management process. They should not be expected to prescribe exhaustive technical solutions to the problems posed by hazardous materials and wastes. Such problems are too complex in themselves to be adequately treated by a single work such as this one. They are also highly facility-specific. More exhaustive treatment of the technical problems posed by hazardous materials and wastes exists in literature on the subject, which is ref- erenced in the Bibliography (pages 39-40).

Programs for Managing Hazardous Materials and Wastes Throughout this update, references are made to the establishment of “programs” to handle various aspects of the overall hazardous materials and wastes problem. A program includes two things: (1) written materials that describe systematic policies and procedures for dealing with a specific problem, and (2) regular and ongoing review of the effectiveness of these policies and procedures as they are carried out during the day- to-day activities of facility personnel.

The policies and procedures that make up each program described in this monograph must account for and appropriately control the risks that hazardous materials and wastes pose to patients, personnel, visitors, and to the community and surrounding environment. Risk control consists of two basic components: (1) the appropriate use of technology, including technology for patient treatment, for conducting laboratory tests, and for handling and disposing of hazardous materials and wastes; and (2) the provision of appropriate training for individuals who use, handle, or are exposed to hazardous materials and wastes.

Foundations for developing a program can generally be found in scientific literature on hazardous materials and wastes. Federal, state, and local regulations governing such material are also a useful source of technical information.

JCAH’s plant, technology, and safety management standards ask facility personnel to define, plan, and operate programs that combine technology, training, state-of-the-art knowledge, and government regulations to manage hazardous materials and wastes.

7 Managing Hazardous Wastes and Materials

JCAH surveyors will not look for “violations” of government regulations, although organizations need to be aware of and comply with applicable regulations. Rather, JCAH will survey a facility’s methods of organization and carrying out all of its programs to control those materials designated as hazardous. These programs are components of a facility’s overall program for managing hazardous materials and wastes, which is described in JCAH standards.

The hazardous materials and wastes program is a

part of a facility’s program for plant, technology, and safety management, which is in turn a component of the overall quality assurance process that JCAH standards ask facilities to implement. Looking always toward better ways of assuring organizational quality, we at JCAH hope that this monograph will aid in the development of effective programs for managing hazardous materials and wastes in health care organizations nationwide.

Managing Hazardous Wastes and Materials 8

Chapter 1 Waste Disposal: A Historical Perspective

Before the most recent period of human history, waste disposal was not a major problem; through most of our recorded past, trash was either biodegradable or reusable. Natural contaminants were once easily handled by the natural ecosystem, sewage dumped into a river was diluted and bioconverted after traveling a few miles downstream, and people tended not to live close enough together to have to worry about each other’s refuse. Only in the last two centuries have products designed for human use needed to be discarded in any special way.

The earliest problems with waste disposal occurred in medieval towns, which were built without sewage systems. Toilet facilities were usually close to water supplies, which caused many diseases. Still, collected piles of trash of any kind were rare. People tended to use and reuse whatever they owned, and what they did discard easily rotted back into the earth.

As towns increased in size, their inhabitants came to recognize that wastes, particularly human and ani- mal wastes, needed to be separated from drinking water and be collected for removal. This recognition came relatively late in our history, after the lack of sanitary practices had caused much suffering, disease, and death. Early collectors of waste (“honey dippers”) were privately employed and removed wastes pri- marily to use the saltpeter in them for manufacturing gunpowder. These collectors were eventually supplanted by municipally hired waste collectors, which were the ancestors of today’s garbage and sanitation workers.

Methods of disposal before the eighteenth century were the same as those the cavemen probably used: wastes were buried, burned, or stacked in areas that were useful for nothing else. We still use the same methods. We call them landfill, incineration, and dumps.

Waste in the Modern Era The Industrial Revolution (circa 1750-1850) ushered in-along with sweatshops, child labor, and other problems-industrial waste and pollution. It was not profitable to remove wastes produced by factories; thus such wastes were often merely discarded near the factory grounds. Huge piles of trash developed. The coal industry, for instance, literally built mountains out of the rock and other material separated from coal and gave no thought to removing them.

The manufacture of materials such as plastics, industrial chemicals, and high-technology products cre- ates by-product wastes that do not fade back into the

earth when discarded. Such wastes have been discarded, over the course of time, without great concern about their overall impact on the environment. In addition, some high-technology materials have themselves been found to cause serious environmental problems. An example is that of the polychlorinated biphenyl (PCB) fluids that were developed for electrical transformers. PCB fluids have high di-electric (insulating) properties and enable the construction of transformers of lower weight, less cost, and greater capacity than other types of transformers. As long as they were properly contained, the PCB fluids were safe and effective. No one gave much thought to the possibility that the fluids might accidentally leak sometime. Eventually this happened and hundreds, possibly thousands, of people have become ill or suf- fered birth defects as a result. To make matters worse, the PCB fluids are expensive to destroy. They are a significant part of today’s toxiclhazardous waste crisis.

Decades ago, when our chemical and technological industries first began considering waste disposal as a technical problem, the ways they decided to deal with it resembled the methods of our primitive ancestors- they either buried or burned it. Burial was the most common method used because it was easier and was considered safer. In fact, it was considered the state- of-the-art method for a long time-so much so that the federal government used special sites to bury the most hazardous forms of chemical-warfare wastes. The effects that such materials as chemical-warfare wastes might have on nature by entry in to the water supply-not to mention the consequences of building houses on the contaminated land-could not have been predicted earlier in this century; even the most pessimistic environmentalists would have been satis- fied that the wastes had been safely eliminated.

Today, the public has become aware of the problems that result from improper disposal of hazardous wastes. Public awareness has increased not only because of the disasters that have been caused in some areas by the accumulation of toxic materials disposed of by previous generations but also because waste has become integrated in the very process of living in a technological culture. W e now spend more on the packaging of most foods, for instance, than the raw food itself costs; we design for disposal.

Challenge to Health Care Facilities Only in the last few years has waste become a significant topic for discussion in the health care industry. For years, the only waste-disposal problem given se-


Waste Disbosal: A Historical Persbective

rious attention in health care facilities was that of pathological wastes (ie, tissue specimens and potentially infectious materials from the human body), which were mostly an aesthetic and, possibly, a public health problem. Many other types of waste were ignored. For example, “sharps”-materials with sharp edges or points, such as needles or broken glass-were casually thrown away with ordinary trash, with the result that housekeeping personnel and trash handlers were injured and sometimes infected. And chemical waste has simply been tossed into the compactor, which has resulted in fires, irritating smoke and injury or illness.

Today health care facilities are among the heaviest users of disposable materials. Such materials are cheaper than nondisposable materials, and today’s cost-conscious health care facilities have come to the point where most materials they use are designed to be disposed of after use. Ironically, at the very time the health care industry is using more and tossing it faster, waste disposal is becoming much more difficult. Burying waste, burning it, and piling it up will no longer work. Landfills are filling up, and land in which waste can be buried is becoming harder to find; incineration is still expensive; and the sheer quantity

of waste today rules out the notion of piling it up. To make matters worse, more and more of the

wastes that health care facilities discard are being considered hazardous and can no longer be treated casually, as though they are nonhazardous materials. They have acquired special classification that demands systematic handling. For example, sharps, chemotherapeutic wastes (see discussion, Chapter 2, page 1 l), radioactive materials used in laboratory tests, and even nonhazardous wastes that have been or may have been contaminated are now called “biohazardous” wastes and must be treated as such.

Facility administrators need to take a careful look at their programs for handling wastes in light of recent discoveries concerning the types of hazards they represent and in light of technological developments for handling them. The chapters that follow provide a basic guide for handling, transporting, and disposing of most of the wastes found in health care facilities. In addition, some instruction is given for guarding against and controlling accidents involving hazardous materials. JCAH standards relating to these problems, as well as recent developments in government regulations concerning the definition of and methods for disposing of hazardous wastes, are also discussed.


Chapter 2 Types of Hazardous Wastes and Methods for Handling

A “hazardous material” is any material in use that is considered to represent a threat to human life or health. A “hazardous waste” is a material no longer in use that represents such a threat. Once a material is used, contaminated, or determined to be in excess of an amount required, it should be considered waste.

Most health care facilities have to deal with a variety of wastes classified as “hazardous.” These wastes tend to fall into several groups: sharps and chemical, infectious, chemotherapeutic, and radioactive wastes. Each type of hazardous waste is defined in this chapter, and fundamental problems involved in handling each type are discussed.

Methods for handling each type of waste should be outlined in and monitored according to a written program developed by appropriate facility personnel. The program should be described in writing. The plan for handling each type of waste should be part of a facility’s overall program for handling hazardous materials and wastes, aspects of which are discussed in other chapters of this monograph.

Chemical Wastes Chemical wastes can come from a variety of areas in a health care facility. Laboratories are a primary source, but chemicals are also used in such departments and services as housekeeping, foodservice, maintenance, laundry, and occupational therapy. The actual chemical waste involved may be as simple as a bottle of acid no longer in use or may be as complex as the aqueous wastes from laundry and foodservice. Such aqueous wastes need to be tested to assure that they (1) fall into proper pH ranges, (2) have less than maximum biological oxygen demand (BOD) and chemical oxygen demand (COD) levels, and (3) will be accepted for processing by the sewage treatment plants.

Chemical wastes generally must be collected at the point of use (ie, the site and time of use) and segregated into containers intended for only one kind of chemical waste. Chemical wastes are the worst wastes to mix, as mixtures are not only more expensive to handle (see discussion in Chapter 4, page 2 l), but also can react together and cause serious problems, such as explosions and/or deadly gas emissions. To address hazards posed by inappropriate mixtures of chemicals or by the chemicals themselves, an organization must establish a management program that includes labeling, removal, filling, storage, and disposal of hazardous materials and wastes. The following is a simple, generalized, step-by-step process that could be used to handle and transport chemical wastes:

9 The components of each type of chemical waste are clearly labeled.

9 If the original label is unclear, damaged, or miss- ing, or if the container holds material that is dif- ferent from the original material, a new label should be attached. The label clearly indicates that the material is “hazardous waste” and lists the components and strength of the waste and the type of hazard it represents, if the type of hazard is not obvious. Labeled containers are removed from the area where they are used as soon as practical after filling, to reduce the hazards in that area. The chemical containers are picked up in sturdy carts and transported in plastic or fiberglass tote boxes so that if a leak or spill occurs, i t can be contained in the box.

9 Personnel who transport chemical wastes are trained to deal with spills and leaks. Each cart carries some absorbent for emergency use. Tote boxes are not overfilled, and the materials in a tote box are chemically compatible.

When material is taken to a temporary storage area, it should be stored on sturdy shelving or stored by another method of supporting and keeping i t steady; then it should be segregated by hazard class and separated by space. Due consideration of the hazards would dictate that flammables be kept in a flammable-liquid storage cabinet, that acids and bases be kept separated, and that irritants and highly volatile materials be placed in appropriate ventilated storage, under slight negative pressure, so that odors and vapors will not escape. (Using “negative pressure” means lowering the air pressure in an enclosed space so that the more “positive”-that is, higher-air pressure outside the enclosed space moves air into the area rather than letting air out of it, thus preventing gases and vapors from escaping.) Care should be taken to assure that materials stored together will not react. Lists of incompatible chemicals should be available for personnel who handle waste-chemical storage.

Chemical disposal is generally carried out by chemical disposal contractors, who come to a facility, package the materials in a manner that meets U.S. Depart- ment of Transportation specifications, haul the materials to a transport, storage, and disposal (TSD) site, and provide documentation in the form of a manifest and a certificate of the legal disposal. A “manifest” is a legal document that must be completed for each shipment of waste material to a disposal site. A


Tybes of Hazardous Wastes

“certificate of legal disposal” is a document returned to the facility certifying that the wastes were handled and disposed of in an appropriate manner. (See also the discussion of manifests in Chapter 10, page 37.) Contractors often charge high fees, and i t may take some searching to find one that will meet a specific facility’s needs.

Contractors should be very selective about what they take and about what condition it is in because they must package, transport, and dispose of waste materials in strict accord with complex and comprehensive regulations. If they cannot handle some kinds of hazardous materials, generally they can assist in finding someone who can, or they can suggest methods of neutralizing the material to the point where they can handle it.

Most contractors work on a regular pickup basis, and many also operate on an as-called basis. However, under general requirements of the law, hazardous materials should not be kept for longer than 90 days; thus a contract for regular, quarterly pickup may be the best, least expensive option. A yearly contract for regular pickup is less expensive for large organizations that must dispose of large amounts of hazardous wastes.

Infectious Wastes Infectious wastes (also called “biohazardous wastes”) may include the following: wastes from rooms housing patients who have diseases resulting in hazardous body wastes; wastes from rooms housing some categories of isolated patients; some kinds of laboratory wastes; and pathological wastes-a category of infectious waste that generally includes surgical specimens, gross tissues, and solid wastes (eg, blood clots).

For both aesthetic and health reasons, pathological wastes are ideally incinerated in a Class VI incinerator (ie, one of sufficient heat capacity to incinerate human tissues).” If such an incinerator is not available at a health care facility, local funeral homes may have cre- matorium facilities that can be used. In some in- stances, such wastes are buried in cemeteries.

Other infectious wastes may be incinerated, autoclaved (ie, exposed to steam under pressure to destroy infectious microorganisms), or chemically treated for disposal. Wastes that are to undergo such processing should be handled and transported in accord with an established plan that recognizes appropriate precautions that should be taken to prevent accidents during processing. Such a plan might include the following:

*Class VI incinerators are designed to incinerate materials such as human tissue, which has low combustibility and is water-laden. These incinerators have heat input high enough to vaporize the water and afterburners to assure that vapors, smoke, and any particulates are exposed to sufficient heat to destroy any resultant materials. Usually the afterburner flame impinges directly on the materials to be incinerated and produces temperatures (on the area of the material in direct contact with the flame) of 1800’ F (1000’ C) or more. For further information see Bond et al, page 276.

Infectious wastes are bagged or double-bagged at the site where they are produced and are transported in a closed container. Ideally, the transportation route avoids patients, food, and clean materials (eg, linens and other materials assumed to be free of infection. The materials are processed as quickly as possible or packaged for transport to off-site incineration. If off-site incineration is chosen, the containers are sturdy, leakproof, and clearly marked.

(usually an autoclavable bag) should have an indicator on it that darkens on exposure to heat and s team-or some similar measure should be taken to demonstrate that the bag has been processed before being put into nonhazardous waste. Systems that use autoclaving also assure suitable testing of the effectiveness of the autoclave with spore strips (ie, by exposing heat-resistant bac- teria to the autoclave and then placing them in a culture to see whether any are still alive), or by a variation of this method. Generally, personnel in central supply or sterile processing services may be able to provide advice about how to test the autoclave with the spore strips and how to read the results.

-

If in-house autoclaving is chosen, the outer bag -

Sharps “Sharps” are objects capable of puncturing the skin, such as hypodermic syringe needles, blades, and suture needles.? It is not mandatory that a facility design and implement a special, formal program for handling sharps, but if a facility opts for such a program, it would be a component of the facility’s overall program for handling and disposing of hazardous wastes, as described in the Introduction, page 7, and in this chapter, page 11. The sharps program would have to be flexible enough to apply to all areas of a facility in which sharps may exist and would have to be enforced and monitored for effectiveness.

The major element in a plan that a facility develops to handle sharps would be to collect them at the point of use, generally in containers at the area of use. Many types of containers are available in the marketplace, but some types are themselves hazardous. A container should have a large opening to allow sharps to be dropped into it. If the opening is covered by non- transparent flaps, however, the person disposing of the sharp cannot see inside the container. This is dangerous because the sharp must be pushed into the container and another sharp that could injure the hand may be just inside.

Containers should be available in various sizes, including small containers that can be put on a specimen collection tray; medium-sized containers for col-

~~ ~

?Currently available literature provides detailed discussion of the problems posed by sharps. See, for example, Crow (1985) and Lar- son and Manni (1984). See Bibliography (pages 39-40).


Typa of Hazardous Wastes

lecting bottles and syringes used in sterile preparation services, physical therapy areas, occupational therapy areas, nursing areas, and outpatient clinics; and large containers for areas where sharps are in heavy use, such as operating rooms, intensive care units, recovery rooms, anesthesia work areas, and pharmacies. The containers should be capable of being securely closed when full, and they should be transported for processing in such a way as to avoid mixing with nonhazardous trash.

The containers chosen will, to some extent, depend on the final method of disposal. If incineration is used, the container should be made of materials that will incinerate completely. If an autoclave is used to disinfect materials before disposal in ordinary (nonhazardous) trash, the container should not melt or warp excessively in the heat used. If the container will go directly to the compactor for landfill, it must be able to tolerate compaction without damage that would allow sharps to be spread around the landfill.

Other considerations for an effective program to dispose of sharps include the following:

Sufficient containers are available to prevent overfilling. Spare empties are available in the use areas to avoid overfilling, and there are clear policies and procedures on how to deal safely with filled containers. Needle cutting and recapping are avoided when sharps are being collected because recapping needles can injure the fingers and cut needles create unnecessary hazards. Collection containers are designed to allow direct disposal of uncapped syringes, and the containers are resistant to needle punctures. Containers are capable of containing liquids. This is necessary because syringes and intravenous (IV) sets often leak. Cardboard boxes generally should not be used unless they have some form of liner to contain liquids. Such sharps as IV bottles, IV sets, broken glass, blades, and suture needles are properly disposed of from operating room and emergency room areas.

Chemotherapeutic Wastes As our scientific understanding has progressed, more types of waste have been classified as hazardous. Within the last few years, a new category of hazardous waste has become a major issue in the health care industry: chemotherapeutic wastes. *

Chemotherapeutic materials (also called antineoplastic and cytotoxic materials) are now recognized as a hazard to pharmacists, nurses, and other person-

#Currently available literature provides detailed discussion of the problems posed by chemotherapeutic wastes. See Bellospirito (1984) and Stellman (1984). See Bibliography (pages 39-40).

13

ne1 who may come in contact with these drugs, which are used in chemotherapy. Such drugs are often strong carcinogens, toxic agents, and/or corrosive materials. Appropriate precautions must be taken during preparation, transport, administration, and disposal of these materials.

Chemotherapeutic materials should be prepared for use in a biological safety cabinet, that is, a unit designed both to keep the chemotherapeutic material pure and to protect personnel against any of its harmful effects. A biological safety cabinet recirculates air in the work space through high-efficiency particulate air filters to remove hazards and prevent particulate contamination of the work environment.

To further control risks posed by such materials both before and after they are used, preparation and administration of chemotherapeutic and other drugs should include the following considerations:

Chemotherapeutic and other drugs are prepared in biological safety cabinets, or under some similar type of protection, by personnel wearing appropriate gowns, gloves, and masks. Preparation activities take place on an absorbent pad, and the pad, plus all contaminated preparation materials, is discarded in a designated chemotherapy disposal container. The prepared chemotherapeutic materials are transported in a leakproof container and are hand (or cart) carried, not sent by tube or through a similar transport system. One method of protection is to contain the prepared drug and other materials that are used to administer i t in a zipper-type plastic bag. The bag can then be used to contain the wastes and be disposed of with them. In the areas of a facility in which chemotherapeutic drugs are administered, the patient is suitably protected against accidental skin contact with the materials, some of which are strongly alkaline and some of which are suspected to be car- cinogenic agents. Protection should be used to guard against potential skin and chromosomal damage. The nurse or physician who administers the drug is suitably protected. The syringe or IV set is purged into gauze or other absorbent-not into the air. After administration (or after starting a long-term IV), the contaminated materials are collected and placed in a leakproof container (eg, the zipper- locked bag they were delivered in) and discarded into a dedicated disposal system (ie, a disposal system used for only one kind of waste). The long-term IV bags and set are also collected and properly discarded. Postadministration wastes, together with the preparation wastes, are packaged properly for incineration and are incinerated at 1000" C (1800' F) or higher.

Managing Hazardous Wastes and Materials

Tvbes o f Hazardous Wastes

Generally, chemotherapeutic wastes are collected in all-fiber drums, are sealed and labeled, and are then taken away for incineration.

Radioactive Wastes Most of the radioactive materials used in laboratories and clinical settings are low-level materials, that is, materials that emit low-level radioactivity, thus posing no immediately life-threatening health hazard. * High-level materials-materials that emit high-level radioactivity, such as cobalt-are usually handled by highly trained specialists.

Low-level materials, such as scintillation cocktails and Bac-Tec vials, represent the largest portion of radioactive materials used in health care facilities (ex- cept in nuclear medicine services). Other materials used in a clinical setting are of such short half-lives that, once they have been used and become wastes to be disposed of, they can simply be held until they decay to background levels (ie, to the point at which they emit little or no radioactivity) and can be handled as nonradioactive wastes.

The general techiques used to reduce or handle radioactive wastes include concentrating and confining a material and sending i t to a specific landfill; incinerat- ing; storing until radioactive decay is complete, which is difficult for long-lived materials such as carbon 14; and diluting (discharging the material into sewage and the atmosphere).

Concentration-also called “volume reduction”- will become increasingly necessary regardless of what final method of disposal is used because concentration reduces costs. Concentration includes compaction (ie, the crushing of a material until i t fits into a smaller space) and the repackaging of high “dead-volume’’ materials (ie, materials that take up only a small amount of the available space in the containers in which they are stored), such as the material in scintillation vials. Dead-volume material from a number of containers can be combined and repackaged in one container.

As long as landfill continues to be an option, compaction and landfill will probably offer the least expensive way of disposing of radioactive wastes. Dis- posal of radioactive materials in landfills is becoming increasingly difficult, however; landfills used for this purpose may not be available for much longer in some areas of the country. Where landfill is no longer an option, other methods must be considered. These methods include incineration, chemical treatment, and substitution (eg, using hydrocarbon-based scintillation fluids, which can be diluted and dispersed harmlessly into the environment). Recycling and reuse can also be used for some radioactive materials. All of

these methods are more expensive than landfill, though they may become more economically attractive when landfill costs rise high enough.

Discharge of radioactive wastes into sewers and into the air, with their resultant harmless dilution and dis- persion, are still viable options as long as the amounts of waste material discharged are nominal and the regulations of the Nuclear Regulatory Commission (NRC) and local requirements are met. Many of the relatively high-volume radioactive waste streams (see discussion of waste streams in Chapter 5, page 23) can be discharged into the natural environment, and the availability of all-aqueous scintillation cocktails (with no toluene or other hydrocarbons) will make this type of disposal more acceptable. However, the long-term effects of disposing of low-level wastes in nature are not yet known and may be found to be a problem in the future.

The disposal of radioactive gases should be as direct as possible; ideally, disposal should be through a dedicated exhaust (ie, an exhaust used for only one purpose) to the roof. Where such exhaust lines are not practical, the gases must be captured by alternative means, such as charcoal filters. When devices like charcoal filters are used, they must be checked con- stantly to assure that the gases are actually captured and not recirculated into the facility.

Incineration, particularly of hydrocarbon-based scintillation cocktails and very low-level material, such as contaminated gloves and glass, will probably continue to be the most acceptable practice for the near future. Incineration destroys all the materials and even destroys their chemical identity; for example, it breaks radioactive hydrocarbons down into hydrogen and carbon. It also appears to release nonhazardous amounts of radioactive materials in the atmosphere.

Monitoring of the methods chosen to handle radioactive waste is necessary to assure the safety and integ- rity of the methods. Fortunately, most available methods are not hard to develop and are usually effective. This is because radioactive materials can be monitored and detected more easily than many other hazardous materials and wastes. Moreover, federal and local regulations for such surveillance are much more clearly defined than the federal and local regulations addressing other kinds of wastes; thus, federal and local regulations provide more specific guidance for facilities seeking to develop methods of monitoring radioactive wastes. Federal and local laws also require that areas in which radioactive waste was stored, used, or tested must be tested after the wastes are gone to assure that all hazardous materials have been suffi- ciently eliminated.

In all facilities using radioactive material the pres- ence of a radiation safety officer is required by federal and local law.? This official’s role in the identifica-

‘Currently available literature provides detailed discussion of the problems posed by radioactive wastes. See, for example, Falck (1984) and Philip (1984). See Bibliography (pages 39-40).

?See the Code of Federal Regulations. State regulations and NRC regulations may also be consulted.


Types of Hazardous Wastes

tion, control, and surveillance of radioactive materials is clearly identified in NRC regulations. It is also explained in written material on the individual licenses that are issued by the NRC to all users of radioactive materials for each instance in which radioactive materials are used in a given institution or by a specific person. A facility’s radiation safety committee (also required by federal and local law)” is the facility’s final authority on the acceptability of various methods of handling and disposing of radioactive materials. But the radiation safety committee should work with the facilitywide safety committee to fit the handling methods chosen into the framework of the facility’s overall program for managing the handling, storage, and disposal of hazardous materials and wastes.

As stated in JCAH’s plant, technology, and safety management standards, a facility is expected to establish a safety committee to review and manage overall safety-related problems. Although the radiation safety committee bears primary responsibility for protecting personnel, patients, and visitors against radiation hazards, the radiation safety committee should keep the overall safety committee informed of the radiation safety committee’s activities, plans, and recommendations. In most facilities, a liaison or concurrent mem-

“See the Code of Federal Regulations. State regulations and NRC regulations may also be consulted.

ber will effectively assure that issues are brought before both committees as needed.

The radiation safety committee should also be involved in the facility’s overall hazardous waste program. In particular, the committee should be involved in hazard surveillance.

Conclusion The various types of wastes in a health care facility are generally classifiable as chemical wastes, infectious wastes, sharps, chemotherapeutic wastes, and radioactive wastes. A facility’s program for handling wastes should be cognizant of the hazards posed by each of these waste types and should include methods of monitoring and controlling the movement of each waste type through the facility premises. These general classes of waste are also recognized in federal and local regulations, which provide technical guidance in appropriate methods of disposal.

A facility’s program for handling any of the waste types discussed in this chapter should also define the physical locations within a facility that produce such wastes or that use hazardous materials. Chapter 3 discusses the various sources of hazardous waste in a facility and the places where hazardous materials are often used.

I5 Managing Hazardous Wastes and Materials

i

Chapter 3 Hazardous Materials and Wastes in Specific Service Areas

Patient care areas, laboratories, physical plant services, laundry areas, foodservices, outpatient clinics, and occupational therapy areas are some of the major sources of hazardous waste within a health care facility. These services also frequently use hazardous materials. This chapter provides guidelines for the safe handling of the hazardous materials and wastes that cause the most frequent problems in these specific service areas of a facility. Table 1 summarizes types of hazards originating in these areas and also in physical therapy areas, sterile preparation services, operating rooms, and intensive care units.

Patient Care Areas Patient care areas have some infectious wastes, some chemotherapeutic wastes, and many sharps. The most important goal in patient care areas is to protect patients and visitors as well as staff. Wastes must be labeled and be taken to designated locations, such as utility rooms for soiled materials (eg, linens).

The methods for handling infectious and therapeutic wastes that are discussed in Chapter 2 are relevant

for patient care areas. In such areas, sharps are a hazard that especially must be watched. Containers overfilled with sharps pose a real hazard to patients and visitors. Personnel who are responsible for developing plans to manage sharps in long term care and hospice facilities should take note that staff in these facilities use sharps less often than in other health care facilities and thus it takes correspondingly longer for collected sharp wastes to fill containers. To minimize contamination or odor in the environment, such containers may therefore need to be treated with a disin- fectant or a deodorant, or perhaps smaller containers will be more appropriate.

It is particularly important that containers be kept tightly shut and secured so that they cannot be stolen.

Laboratories Laboratory wastes may include chemicals, sharps, infectious wastes, and radioactive materials.

Chemical wastes would include used chemicals, reagents, and solutions; outdated materials; and contaminated chemicals or questionable chemicals, that

Table 1. Areas of a Health Care Facility Where Hazardous Materials and Wastes May Be Found

Chemo- Chemical infectious therapeutic Radioactive wastes wastes Sharps wastes wastes

Patient care area

Laboratory

Physical plant services

Laundry area

Foodservice

Occupational therapy/ physical therapy areas

Sterile preparation services

Operating room/ intensive care units

Outpatient cilnlc

Rare

Yes

Yes

Yes

Yes

Some

Some

Yes

Rare

Yes

Yes

Rare

Yes

Rare

Rare

Some

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Rare

Rare

Yes

Rare

Rare

Yes

Some

Yes

Rare

Yes

Rare

Rare

No

Rare

Rare

Rare

Rare

Note: This is not an exhaustive list of all hazardous materials and wastes or of all areas where they may be found.


Hazardous Materials and Wastes in Specific Service Areas

is, chemicals whose identity is unknown or that are suspected of contamination or of being mixed with other chemicals. Most hospital laboratory staff tend to hold onto old chemicals that are not really needed: materials that were used in procedures no longer followed, extra supplies of chemicals that are kept in case normal supplies are exhausted (which then often end up becoming too old to use anyway), and partly filled bottles of chemicals that were not discarded. Hoarded materials not only take up a large amount of useful storage space but also create unnecessary hazards for facility staff; furthermore, if an accident results, the institution faces financial and legal troubles.

Laboratories should be carefully purged at least every six months, as part of a routine hazard surveillance program; materials that have not been used since the last purge should be identified and removed. (“Purging” is a term for a type of hazard surveillance inspection conducted by a facility. A purge focuses specifically on hazardous chemicals with the intent of removing all hazardous materials that are outdated, contaminated, or no longer needed.) Certain dangerous items should especially be watched for: picric acid (an explosive when dry), old ether (ether should be discarded no more than three months after opening, or checked for peroxides), and sodium azide. There are also other known hazards that laboratory personnel should identify and control.

Sharps used in laboratories include Pasteur pipettes and disposable glass in general, hypodermic syringes, microscope slides, vacutaners and other specimen containers, and used reagent bottles. A clear policy for the disposal of sharps is needed. The policy should recognize that many sharps may also be infectious. Collection containers for sharps may be required by an overall facility sharps program, if the facility has one, or may be unique to the laboratory. In any case, laboratory personnel must consider the following:

Ways to collect and separate sharps from regular waste, Containment of the sharps, Prevention of penetration of the container, and Appropriate transport of the discarded sharps to a place where they can be processed and ultimately disposed of.

The sharps container should be of a design that will not allow contaminated material to get loose in a compactor or landfill. For instance, if the container is to be autoclaved, it must be capable of resisting the heat, steam, and pressure of the autoclave; if it is to be buried in a landfill, the container top must be secure.

Infectious materials in the laboratory would include all patient specimens and any materials contaminated by them. Many specimens can be rinsed into the sewer system, but clots and other solids may not be safe for or legally permissible in the sewage system; facilities should check with local authorities. Infec- tious solids (eg, blood clots), tissue, and similar mate-

rials from the human body would probably be handled as pathological wastes (ie, they would either be burned or buried). Wastes that have been produced by or have been in contact with patients suffering from such disorders as the acquired immune deficiency syn- drome (AIDS), the Creutzfeldt-Jakob disease, or the African hemorrhagic fever would also be burned or buried. A facility’s infection control committee should be consulted for assistance and direction in handling such hazards. This is in keeping with JCAH’s plant, technology, and safety management standards, which ask the various administrative committees within a facility to communicate with personnel working close to hazards throughout the facility.

Radioactive materials, including such low-level materials as BacTec, should be handled in strict confor- mance to the terms described in the Nuclear Reg- ulatory Commission (NRC) license. Questions and problems should be directed to the radiation safety officer. Personnel in most clinical laboratories do not use any high-level radiation sources; but low-level sources, such as scintillation and BacTec vials, need to be strictly tracked and accounted for. Spill kits and procedures for handling spills of radioactive materials should be available wherever such materials are used, and regular contamination testing of a work area is required by the NRC license to use radioactive materials.

Although laboratories contain as many hazardous materials as other areas in a health care facility, and usually more potentially hazardous materials as well, laboratory staff generally put great effort into controlling them. However, laboratory personnel must con- tinually try to improve their efforts because many laboratory materials can cause problems in areas of a facility outside the laboratory if they are disposed of inappropriately.

Physical Plant Services Physical plant services include maintenance, engineering, and facility services. The many hazardous materials that are in use by physical plant services include solvents, cleaners, chemicals for water treatment, coatings and finishes, lubricants, cutting oils, and fluxes. Too often these materials are not recognized as hazardous and are handled inappropriately, partly because many people consider what something will do for them, not what it will do t o them. Physical plant personnel are often under a great deal of pressure to get their work done and may not take necessary precautions.

Not only is a careful program to track such hazardous materials needed, but an effective program” is

“Please see the introduction to this monograph for an explanation of the word “program.” Programs for training employees to recognize and properly handle hazardous materials and wastes should be part of a facility’s overall program for handling hazardous materials and wastes. Training programs are discussed in Chapter 9, page 33.


Hazardous Materials and Wastes in Specific Service Areas

also needed to train employees in their safe use. Facil- ity staff must also assure that less obviously hazardous materials, such as lubricating oils from compressors, used solvents, and used cleaners, are disposed of in accord with federal and local regulations-not just dumped down the sink.

Laundry Areas The laundry uses many cleaners, sours, bleaches, and detergents that are potentially hazardous in their concentrated form before use. Also, if they are used im- properly, or if some of them are accidentally mixed, they could cause immediate hazards and some disposal problems.

Cleaning chemicals are shipped to a laundry in large packages and thus can cause immediate receipt and handling problems, such as spills and leaks. Those responsible for receiving potentially hazardous laundry materials should know how to respond to such problems. Storage space should be sufficient to contain the amounts of these materials that are necessary for reasonable operations (about two weeks’ worth).

To reduce hazards to staff, the materials should be handled as little as possible, and appropriate personal protective equipment should be available and its use enforced. If it is necessary to feed chemicals to a machine manually, extra care should be taken to be sure that appropriate protective measures are taken.

In many areas, the sewage outflow (the point at which sewage flows out from the building and joins the public sewage system) must be tested to assure that the chemical oxygen demand (COD) is not excessive, and that the p H level is within acceptable limits. The laundry also may have problems with such other hazardous materials as sharps, infectious wastes, chemotherapeutic contamination, and radioactive contamination.

Sharps must be protected against in “soiled sorting,” the area for sorting soiled laundry. Sharps found in soiled sorting will include hazards such as therapeutic instruments and hypodermic syringes left in the linen. Other hazards found in soiled sorting could include drugs, drug-contaminated materials, and contamination from “undiagnosed” infectious soiling (eg, blood from the broken arm of a patient in physical therapy who has as yet undiagnosed hepatitis B).

Suitable protective measures must be taken to reduce the potential for injury or illness. Useful protective measures might include the following:

Sorting procedures designed to prohibit staff from exerting physical pressure against linen with the hands until after the linen has been spread on sorting racks, tables, or bins. This prevents injury from sharps and contamination. Equipment such as tongs, hooks, or magnets that allow sharps and therapeutic instruments to be retrieved without hand contact.

Appropriate storage for retrieved sharps and therapeutic instruments. Procedures to assure that sharps are processed through a facilitywide sharps program, if one exists, to reduce the chance of improper disposal. The delivery of contaminated linens to the laundry from patient care units in “wash away” bags, usually made of polyvinyl alcohol or similar material, and then bagging again (“overbagging”) in a secure container, such as a heavy cloth bag or a plastic cannister. Arrangement of the linen container to allow the infectious material, still in its water-soluble bag, to go into the washer, where it will be disinfected by bleach and other cleaning materials. Reduction of staff’s exposure to infectious contaminated materials as much as possible. The wearing of appropriate gloves, masks, and gowns where handling is unavoidable. The use of negative pressure (see discussion, Chapter 2, page 11) in the sorting area to reduce the chance that airborne contamination will reach clean linens or enter any ventilation that is arranged to protect the personnel in the sorting area.

Foodservice A facility’s foodservice has many potentially hazardous materials, such as detergents, sanitizers, disinfectants, cleaners, and glass and china. Care and personal protection measures should be available to those who handle concentrated chemicals. Also, thought should be given to the possibility that aerosol cleaners and sanitizing agents will contaminate the air. Adequate disposal and sweeping equipment should be available for handling broken glass.

In addition, sharps (such as syringes), used intravenous equipment, and unused drugs sometimes come into the foodservice area on soiled trays. The origin of each tray should be identified, particularly if there are unused drugs on it, and the appropriate patient care providers should be informed of the wastes and sharps that are found on the tray; this will help to protect the patient and prevent improper handling of drugs and sharps in the future. Containers for disposal of sharps should be placed in the tray-receiving area.

Outpatient Clinics Outpatient clinics have most of the same problems that inpatient care areas do. The same types of disposal should be used for such items as sharps, chemotherapeutic drugs, and infected dressings and materials. It is especially important that containers for the disposal of syringes and drugs in outpatient areas be secure against possible theft. Outpatients are more mobile, are seen for shorter periods, and are under less control than inpatients. Used syringes are valuable to


Hazardous Materials and Wastes in sbecific Service Areas

users of illicit drugs, and outpatient clinics should have very secure disposal procedures. The disposal containers should also be secure against spillage.

Chemotherapy provided in outpatient clinics requires the same level of precaution as chemotherapy in inpatient services. Nursing personnel who prepare doses should use the same precautions and protection that pharmacy personnel use: gloves, gown, mask, biological safety cabinets, and a “disposable work sur- face,” that is, a disposable piece of material on which preparation work can be conducted. To avoid contaminating the patients’ environment, personnel who prepare doses should discard their gowns before entering the patients’ area.

Occupational Therapy Areas A variety of craft materials are often used in occupational therapy areas. Many art and leather materials and some potting materials are hazardous, and the paints and paint solvents used for a variety of projects may be flammable and toxic.

Use of any flammable material around high-heat equipment, such as kilns, should always be preceded by a careful examination of the workplace to assure that ventilation is adequate to prevent any flammable or combustible mixture from accumulating. Ventila- tion should be checked prior to the use of most

paints, paint solvents, leather dyes, liquid and poura- ble plastics, and similar materials that contain solvents or emit strong odors. Suitable disposal should be available for such materials and for any sharps that might be used in arts-and-crafts projects.

Conclusion This discussion has not exhaustively listed all the areas of a facility where hazardous materials and wastes are a concern; neither have all possible types of materials and wastes that could pertain to the facility areas been discussed. The discussion has aimed instead at high- lighting areas of a facility in which hazardous materials are most frequently used and hazardous wastes most frequently produced.

Every facility should survey its premises regularly to identify areas where hazardous materials are used or stored and where hazardous wastes are stored or discarded. All materials and wastes identified should be placed under the facility’s program for managing hazardous materials and wastes. Such a program will in- volve a routine process for handling materials and wastes in a manner that systematically guards against accidental spill or leakage into the rest of the facility environment. Basic guidelines for such a process are developed in Chapter 4.


Idehtifying and Storing Hazardous Materials and Wastes

Health care facilities must process all types of hazardous waste using the following fundamental procedures: All hazardous materials must be

identified and labeled; stored and handled in ways that appropriately

separated from ordinary waste; segregated into groups representing like wastes; packaged or “containerized,” that is, sealed into containers that separate the material from the surrounding environment;

control the hazard they represent;

transported to the temporary storage area; and stored properly in order to be processed for final disposal and eliminated by means permitted under law. (Chapter 5 examines ways of processing for final disposal and discusses disposal methods.)

Identification and Labeling of Hazardous Materials The identification and labeling of hazardous materials and wastes should not be a random, unplanned ac- tivity, but rather a systematic process. The process should be designed not merely for designating certain materials as “hazardous,” but for keeping careful track of their location and their movement through a facility from their point of entry into the facility to the point of final disposal. As stated in the plant, technology, and safety management standards, the identification and tracking process is an essential part of the facility’s overall program for managing hazardous materials and wastes.

Although the standards in the “Plant, Technology, and Safety Management” chapter in JCAH standards manuals do not specifically ask that a separate program be developed for identifying and tracking hazardous materials, such a program is so basic to a suc- cessful system for managing hazardous materials and wastes that a facility without it could be judged defi- cient in operation. The program should be department-specific and should help define what hazard surveillance activities are to be conducted by facility staff. The program’s procedures and its monitoring responsibilities should be updated whenever new items are discovered. This means that a facility should design and implement several policies and procedures.

One policy in an effective tracking process would be to identify a material as hazardous before i t even arrives at the facility. The best time to identify a material as hazardous is before it is ordered. This is the time, also, to determine whether less hazardous mate-

rials that would do the same or an acceptable job are available. Selecting any material for use should follow consideration of the hazards involved in its use. All too often materials are ordered because they were in use before, because a salesman influenced the user, or because no careful search was made for acceptable alternatives. New materials are developed in the course of technological progress; although many new materials are less hazardous than existing materials, often little consideration is given to these new materials and to other alternative ways of reducing hazards. Al- though alternative materials sometimes may cost more than the hazardous materials, the overall cost to a facility may be less when the costs of handling and storing the material and processing and disposing of any hazardous wastes are considered. Ideally, facility staff should select materials representing the minimum possible hazard.

Identifying the potential hazards of a material and considering alternatives are the responsibilities of the department or service that originates the order, and the department or service should receive help from purchasing personnel andor the vendors. All manu- facturers and distributors of materials are required to make information about the hazards of the materials they produce or distribute available in the form of “Material Safety Data Sheets” (MSDSs). The facility has the responsibility for requesting these sheets from the manufacturer. These sheets are designed by the Occupational Safety and Health Administration (OSHA), and they contain information about the physical, health, and fire hazards of the materials and describe appropriate first-aid measures. They are a standardized source of necessary information and should be obtained for all hazardous chemical materials a facility orders. The information in an MSDS also provides data on personal protection as well as emergency phone numbers where additional information may be obtained in case of accident or illness.

The type of hazard (eg, “flammable,” “corrosive,” *‘infectious,” “sharp“j should be included in the ini- tial paperwork involved in ordering a hazardous material so that the personnel receiving the shipment will be aware of the hazards and will treat the material ac- cordingly. The receiving personnel should be equipped to handle the hazards they will be exposed to, should have access to necessary spill containment kits, and should be trained to handle and contain spills and leaks that occur at the time the materials are received or which occur as they are transported to the area of the facility where they will be used. At a minimum, nitrile gloves, absorbents, plastic bags and

21 Managing Hazardow Wastes and Materials

ldentifvinp and Storinp Hazardous Materials and Wastes

containers, and respiratory protection equipment should be available to the receiving personnel. MSDSs should be on file for each hazardous material in use so that facility staff can determine appropriate action to take in emergencies. Sample MSDSs are reproduced in Appendix B.

Storage of Hazardous Materials Once a hazardous material is received from the manufacturer, it should be appropriately labeled with a description of the hazard i t represents. Appropriate storage areas should be used; for example, flammables should be kept in flammable-liquid storage cabinets or in vaults, and bulk corrosives should be stored below counter level but above floor level. Precautions should be taken against accidental mixing of hazardous materials; for instance, strong acids and alkalis normally should not be stored together. However, such materials can be stored together if they are suitably separated, as when they are in separate containers or when they are stored in acid carriers.

Facility staff should determine, and limit themselves to purchasing, the minimum practical amount of a hazardous material to be kept in storage at any time. The amount defined as “minimum” depends on the amount of the material needed for a certain period of use, the ease of obtaining more of the material, and the space available for it. In general, however, large quantities should not be purchased for storage.

Handling Hazardous Materials Handlers and users of a hazardous material should, of course, observe all necessary personal protection measures and environmental controls (see Chapter 7). Those who use or handle the materials on a day-to-day basis should also be trained to know what hazards exist, what personal protection measures to take, what symptoms show that someone is affected by the hazard, and what first-aid responses to make. Emergency- response measures will vary depending on the needs of a facility; but personnel using hazardous materials should know the facility’s policies concerning emergency response, and they should be trained in their portion of the facility’s procedures for dealing with emergencies.

Identification of Hazardous Wastes As stated in Chapter 2, once a material is used, contaminated, or determined to be in excess of an amount required, it should be considered waste unless it can be recycled or processed to reduce the hazards involved in handling it. Hazardous waste must be appropriately labeled with written information that

explains what the material is, its strength (if applicable), and the type of hazard it represents (if not obvious).

Separation of Hazardous Wastes Containers of hazardous wastes should be kept separate, and hazardous materials should never be mixed. Adding as little as an ounce of one type of hazardous waste to as much as five gallons of another can make it a mixture, and a mixture can be far more expensive and difficult to handle than either of the two original hazardous wastes. Adding an ounce of a hazardous waste to a drum of nonhazardous waste makes it all hazardous waste and, thus, makes it more expensive to dispose of; storage and handling problems that nonhazardous waste does not have by itself are also created. Only when two bottles containing an identi- cal hazardous material are more than half empty is it reasonable to combine them. Even so, the empty bottle remains hazardous until cleaned.

Containing hazardous wastes and separating them from other types of hazardous material is imperative when the wastes are being transferred from use areas to temporary storage areas. Usually, hazardous materials should be transferred in closed containers. The containers should be marked to indicate the type of hazard involved; in some cases, containers might be color coded. Packaging should always be designed to contain the type of hazard represented and to separate the hazardous material from the environment.

Temporary Storage The type of temporary storage selected for a hazardous waste should be based on the hazard type represented and should usually be designed to allow appropriate processing for final disposal. Fire protection and ventilation of the storage area should be designed with consideration of the hazards being stored; in some cases, floor drains will make it easy to clean an area because hazardous wastes can be disposed of through them into a sewage system. Floor drains in chemical and radioactive storage areas should be designed to trap the runoff until it can be tested and processed.

Conclusion Identifying, labeling, and temporarily storing hazardous materials and wastes are important in the systematic process all facilities should develop for tracking hazardous materials and wastes from the time they first enter the facility environment to the time they are disposed of. The disposal of hazardous materials and wastes requires an equally systematic approach. Ways of processing hazardous materials and wastes for disposal are discussed in Chapter 5 .


Chatxer 5 Options for Waste Disposal

Most hazardous wastes cannot be adequately disposed of within a facility and must be processed for final disposal. The types of processing used will depend on the final disposal method and the place chosen for disposal. Processing might include segregation and packaging in accord with U.S. Department of Transporta- tion standards for transport, the autoclaving of infectious materials, and the preparation of wastes for recycling.

There are several options for disposal, all of which require preliminary processing: landfill, both sanitary and chemical; incineration, both on-site and off-site; disposal in a sewage system; recycling; and chemical neutralization-or a combination of these. Table 2 describes the applicability of several disposal methods to each of the basic types of waste in a facility. Which

method to use depends on the geographic area and the local legal requirements, the availability and cost- effectiveness of the disposal methods considered, and the policies of the facility.

Landfill Most facility wastes end up in a landfill, unless the facility has an incinerator available. For nonhazardous wastes, which occupy the bulk of the volume and weight of the wastes a facility needs to dispose of, this is fine. Landfill is the least expensive option, although this is rapidly ceasing to be true in most metropolitan areas. For all areas of the country, landfill will be more tightly restricted by federal legislation in a few

~~

Table 2. Disposal Options for Basic Types of Waste

Disposal In sewage incineration Landfill Processing Recycling

Chemical wastes Sometimes Sometimes appropriate. appropriate.

infectious wastes

Sharps

Chemothera- peutic wastes

Radioactive wastes

Appropriate. In- ideal. fectious wastes may need to be processed first.

Not appropri- Sometimes ate. appropriate.

Not appropri- ideal. ate.

Sometimes Sometimes appropriate. appropriate.

Appropriate. A special chemical landfill must be used for many chemical wastes.

Sometimes appropriate. Infectious wastes must be treated first.

Usually appropriate.

Never appropriate.

Appropriate. A special radioactive waste landfill is used for most radioactive wastes.

Appropriate. Sometimes Processing for appropriate. chemical wastes is usually neutralization.

Appropriate. Not appropriate. Processing for infectious wastes is usually autoclaving.

Sometimes Not appropriate. appropriate. Some sharps, such as microscope slides and needles, need to be autoclaved.

Not appropri- Not appropriate. ate.

Appropriate. Not appropriate. Processing for radioactive wastes is usually either compaction or letting radioactive decay take its course.


Obtions for Waste Disbosal

years, due to the Hazardous and Solid Waste Amend- ments of 1984, which are discussed in Chapter 10.

Some biohazardous wastes can be processed by heat (ie, by autoclave) or chemical means to reduce the hazard and allow ordinary disposal. Sharps can be autoclaved and packaged to allow safe legal landfill in most areas.

Incineration At this time, incineration is the ideal method for eliminating most nonhazardous, biohazardous, and physical wastes and some types of chemical wastes. An incinerator totally destroys the waste and leaves a nonhazardous ash that can be put into landfill in almost any area. If an incinerator is available on-site, the volume and weight of wastes can be reduced and many types of hazards can be eliminated. If the incinerator’s heat can be used to generate steam for sterilizing or to generate electricity, the waste’s destruction can be a net profit to the institution. The only disadvantage of an incinerator is the cost of obtaining one; also, under some state and local regulations, it is not possible to get a permit for one (usually because of regional problems, such as air pollution).

With the rise of fuel costs, cogeneration has received interest from many areas of industry. Cogenera- tion is defined as using heat from the incineration of waste to produce steam for generating electricity. An effective program for managing wastes should include consideration of such alternative technologies that reduce the end costs of waste disposal by reducing the cost of electricity or of fuel. Some facilities have found that such strategies meet a significant portion of their heat and energy needs.

Some wastes, such as pathological wastes and chemotherapeutic wastes, are completely eliminated only in a specially designed incinerator. In some areas, an alternative for disposing of pathological wastes is to bury them in a cemetery, which can be very expensive. Most chemicals can be destroyed by incineration at appropriate temperatures, but this generally must be done in specially designed and maintained chemical waste incinerators. Typical incinerators can be designed or retrofitted with injection ports to incinerate many common solvents. Some solvents, however, such as halogenated solvents (eg, chloroform), should not be burned in a typical incinerator because of the pollution they may create. Such solvents require a special incinerator.

Incineration may also be the best method for de- stroying many low-level radioactive materials, such as scintillation fluids and vials. This is an approach that became allowable under Nuclear Regulatory Commis- sion regulations in 1984, but these regulations are not yet recognized by some other government agencies as being fully in effect and are not yet universally carried out. Incineration should reduce the problem of finding acceptable disposal sites and should greatly reduce low-level radiation waste disposal problems.

Sewage Disposal of some hazardous materials through the sewage system is allowed by federal, state, and local law. This approach should be taken with caution, however, as it has been abused in the past by facilities eager to avoid more expensive methods of disposing of seriously corrosive or infectious wastes.

A sewage system is an effective and safe way of disposing of many products, including liquid human waste and liquid specimens from the body; some chemicals, such as common alcohols; and formaldehyde. Facility staff should check with local sewage disposal facilities to be sure that they can handle the materials. Most health care facilities use enough water on a daily basis to dilute the wastes to levels necessary for biodegradation to nonhazardous levels of concentration, but the local sewage disposal facilities should be consulted to verify that the amount of water used is sufficient. Sewage disposal is also an option for those biohazardous wastes that can be ground and chemically neutralized. To dispose of wastes that are processed this way, the supernatant (ie, the liquid part of the processed waste) is drained to the sewer and the solids are placed in landfill.

Care must be taken to assure that the heavy metal content of the outflow from the facility does not ex- ceed Environmental Protection Agency limits. Also, it must be assured that the biological oxygen demand (BOD) and the chemical oxygen demand (COD) are within limits acceptable to the local sewage treatment authority.

Recycling Recycling is the best option for disposing of wastes, if they are recyclable, because this way the material re- turns to useful service. This option is usually not available to health care facilities because they do not produce the necessary quantities of a specific waste stream, that is, one particular type of waste that is processed in accord with systematic handling and disposal procedures.

However, facilities do have some opportunities for recycling. One example of a recyclable product is xylene, a hydrocarbon solvent used in some volume in many laboratories. If several institutions in the same geographic area are interested in reclaiming xylene, they can group together to collect the xylene, have it redistilled to original specifications, and reuse i t . Some laboratory chemicals, such as silver nitrate, can be recycled for silver. Elemental mercury can be collected from instruments such as thermometers and be reused.

Other forms of recycling might include using old materials for less critical applications. For example, outdated acid can be used to acid-wash glassware for the purpose of burning off organic matter, and solvents might be used for heat-recovery burning and fuel mixing, when possible and where allowed by law.


Options for Waste Disposal

Chemical Neutralization Chemical neutralization can be used to eliminate the hazardous nature of some waste streams, such as chemical solutions containing mercury (including those from some automatic blood analysis equipment) and other heavy metals. The amount of heavy-metal contamination in sewage and/or in the chemical waste stream may be significantly reduced by adding solutions that cause the mercury, or other heavy metal, to become insoluble salts and drop out; the heavy metal may then be removed by settling and filtration. Also, neutralization can be used for some highly hazardous chemicals and potential explosives, such as di- isopropyl fluorophosphate or picric acids. The neutralized waste products can be placed in landfills along with nonhazardous wastes.

Conclusion Facilities have a variety of options for the legal disposal of hazardous wastes, and more than one method of disposal can be used for some waste streams. Cost will often be the deciding factor in the selection of a disposal method; however, if a facility maintains a careful program for selecting the minimum amount of hazardous materials necessary for use, overall costs will also be kept to a minimum.

A facility can also reduce overall costs by establishing procedures to control the actual danger represented by the hazardous materials in use. Chapter 6 discusses methods of minimizing the occurrence of accidents related to the use of hazardous materials.


Chapter 6 Ways To Reduce the Hazards of Hazardous Materials and Wastes

There are several time-honored methods for controlling and minimizing the dangers of hazardous materials. In order of decreasing effectiveness, they are elimination of the process, substitution of a less hazardous material for the hazardous material, isolation of the hazardous material, ventilation, and the use of personal protective equipment.

A facility staff will most likely use more than one, or even all, of these methods to protect against hazards. As is the case with all safety measures, the facility staff should see that these methods are coordinated and enforced and that their effectiveness is monitored under a program which is accountable to the facility’s overall program for handling hazardous materials and wastes. Action must be taken to correct any problems identified.

Eliminating the Process The best method of control, obviously, is to no longer use the process requiring the hazardous material. This, of course, is impractical in many cases; hazardous materials are the only substances that can be used in some processes. However, in some cases, such as in a laboratory test using unusual, highly hazardous materials, it may actually cost less to send the test out and pay a premium for it than to maintain the hazardous reagents and pay the cost for disposal.

Substitution A control technique that is much more practical than eliminating the process is substitution-that is, use of a less hazardous material or process to achieve the same result as that obtainable with the more hazardous material or process. There are many examples of this: the use of automated laboratory equipment instead of manual methods, the substitution of lim- onene for xylene in pathology tissue processing, and the use of recently developed water-treatment materials to eliminate certain hazardous bacteriostats, such as sodium azide. Where practical, these methods allow the process to go on as before, but with less risk. This is perhaps the best technique to pursue because once the hazard is substituted, it is gone and will not be a problem.

Isolating the Hazard Another step is to isolate the hazard. An example of this might be the physical enclosure of a tissue proc-

essor in a pathology laboratory. Enclosure of the proc- essor in a hood of nonporous material protects those around it and would prevent, for instance, a fire from spreading or hazardous vapors from being present in the work area.

Another example is the enclosure and venting of an ethylene oxide (ETO) drain system. The area where the ETO/water mixture is run into the drain has E T 0 vapor present from imperfect mixing. A hood arrangement at the drain captures the E T 0 vapor and prevents it from escaping into the room air.

The advantage of enclosures is that as long as they are in place they function automatically, without the need for someone to remember to use them. The only problem with enclosure is the possibility that the barrier between the hazard and the environment might break down. Inspection of enclosure mechanisms should be included in a facility’s routine program for handling hazardous wastes, which includes monitoring of methods of controlling the dangers from hazardous materials and wastes.

Ventilation A less effective type of protection than enclosure is provided by venting and exhausts. Chemical exhaust hoods have been in use for decades; properly used, they do provide effective protection for the technician. Positive and negative pressure (see Chapter 2, page 11, for an explanation of positive and negative pressure) have been used in many health care areas for the control of infectious airborne agents and odors. Utility rooms for sorting of soiled linens, laboratory areas, and garbage areas are usually under air pressure slightly negative to that of the surrounding area.

Controlling the air pressure works well as long as the air pressure actually stays under control; if it does not, a hood designed to function under a specific level of air pressure could fail to protect. For instance, if there are excessive air currents in the work area in which a hood is being used, they may cause hazardous gases or vapors to be pulled out of the hood. This could also happen if the sash of the hood is too high.

Where ventilation is used as a protective measure, extra care must be taken to assure that the design of the hood system, including the air exchanges, exhaust, and enclosure of the work area, is not defeated. It is easy to assume that the hood is working as designed, and often it is difficult to check to assure that the hood is working. Protection systems using ventilation and exhaust require much more surveillance to assure ongoing protection than enclosure

27 Managing Hazardozls Wastes and Materials

Ways To Reduce the Hazards of Hazardous Materials and Wastes

requires. Also, more education has to be provided to assure that the staff in the area know the limits to protection provided by ventilation systems and know the hazards that could occur if the system fails.

Personal Protective Equipment The least effective level of protection against hazardous materials is personal protective equipment (see Chapter 7, page 29). Personal protective equipment, which is simply gear worn on the human body to protect the body against hazards, is an easy method of protection-perhaps too easy. It is inexpensive, read- ily available, and apparently effective; and i t is thus often the first choice of supervisors who do not realize that use of personal protective equipment involves hidden costs.

For example, personal protective equipment needs continuous supervision and surveillance of use. Most personal protective equipment is, at the least, uncomfortable and, at the worst, almost impossible to work in. Human nature can be counted on to make employees want to minimize their use of such equipment. Even if they clearly understand the risks, most people tend to reason “It won’t happen to me” or “I can get away with not using it just this time” or “I’ll only be doing this for a few minutes.”

Such hidden costs as these are what make personal protective equipment the least effective method. Note that such equipment is, however, much better than no protection at all, and personal protection is the method of choice for temporary protection until higher levels of protection are available.

When personal protection is chosen, a comprehensive education program must be instituted so that employees know how the equipment is used, the actual hazards being guarded against, the limits to the equipment’s effectiveness, and procedures for monitoring it and checking to see that i t is operating properly. Such procedures must be organized as part of a facilitywide program for monitoring the use and proper operation of personal protective equipment. Also, strict surveillance must accompany the use of personal

protective equipment, and clear-cut sanctions for non- use of such equipment must be enforced.

Another problem with personal protective equipment is that i t simply does not protect the body as well as the alternative methods discussed in this chapter. For example, respirators can only remove a certain small amount of contamination. Gloves are useful, but certain types of gloves must be selected for protection against specific hazards; the wrong glove type can be worse than no glove at all because some glove materials can absorb and hold contamination against the skin. Latex examination gloves, for instance, offer protection from dust and dirt, but not from chemicals. Surgical masks offer little protection even from nuisance dusts (ie, dusts with no explicit health hazard) and none from vapors or gases.

Personal protective equipment must be chosen by personnel who have undergone comprehensive training, must be replaced at appropriate intervals, and must be checked frequently. Such equipment has its place, if properly used, but it is not a substitute for the more effective methods of controlling the dangers of hazardous materials.

Conclusion A facility might use any or all of the hazard-reducing methods discussed in this chapter. Such methods must be implemented systematically, under a planned program that includes reviewing the effectiveness of the methods used. Systematic use and monitoring of hazard-reducing methods are necessary in any physical location in a facility where employees must work with hazardous materials. The more comprehensive the overall system of protection methods chosen, the lower a facility’s final costs will be.

In most facilities, a program to reduce hazards should also include routine monitoring of hazardous gases and vapors. A variety of monitoring techniques may be used to reduce the risks associated with the hazardous gases used in laboratories and anesthesia services. These techniques are discussed in Chapter 7.


Chapter 7 Methods for Monitoring Hazardous Gases and Vapors

JCAH’s hazardous materials and wastes standard asks that facilities establish a program for the appropriate disposal of hazardous gases and vapors. Some of these are ethylene oxide, a sterilizing gas used in central service areas and in many other areas; waste anesthesia gases, which are produced in operating rooms; and such reagents and chemicals as formaldehyde and xylene, which are used in laboratories. There may be other such gaseous and vaporous hazards that may be identified and must be controlled. The problem with such materials is that they are sometimes odorless and invisible and thus difficult to see or smell.

To be able to respond to emergencies involving such materials, an effective monitoring program must be established to assure that the gases are below levels of concentration in room air permitted by the Occupa- tional Safety and Health Administration (OSHA), the National Inst i tute for Occupational Safety and Health, and the American Conference of Governmen- tal Industrial Hygienists. A variety of monitoring techniques are acceptable to JCAH and other authorities, such as OSHA. Which monitoring methods and equipment are best depends on the type of facility, the level of expertise available, and the availability of outside assistance.

Ethylene Oxide Ethylene oxide (ETO) is a flammable, explosive, car- cinogenic, mutagenic, irritant gas at room temperature. It is used to sterilize materials that cannot tolerate the temperature and moisture involved in steam sterilization. Although very effective, it must be handled with extreme care because of its short-term and long-term toxic effects. OSHA has mandated an acceptable level of not more than 1 part per million (ppm) over an eight-hour time-weighted average (TWA). * This stringent standard, recently imposed, requires that the facility using this gas monitor all personnel who may be exposed to i t and institute strict control measures. To escape having to apply some of the control measures that require more expense and time, the level should be below 0.5 ppm TWA. To demonstrate that such levels are maintained, a monitoring program is necessary. OSHA regulations mandate that potentially exposed persons be monitored and that the monitoring represent an eight-hour averaged exposure.

#See the Ethylene Oxide Standard, part 1910, in OSHA standards.

There are several monitoring methods in use, each with its advantages and problems. One method is to have employees wear badges or dosimeters for eight- hour shifts, then either send these badges or dosimeters to be analyzed by a laboratory or have them processed in the facility. If the badges or dosimeters meet OSHA requirements for accuracy, they are acceptable; however, i t may take a long time for results to be available. Even if results are available immediately, they do not indicate where or when excessive exposure to ET0 may have occurred.

In addition, several types of direct-reading equipment (equipment enabling an immediate reading of gases in the area) are available. Such equipment will not only allow the eight-hour TWA readings to be obtained but also will provide measurements of immediately existing conditions, which is necessary for de- termining where leaks and other problems occur.

Direct-reading hardware is quite expensive, and unless several facilities can share it, i t is probably not economic. Rather than take these measures, a facility may prefer to call in an outside gas-monitoring com- pany to take the measurements instead. Such compa- nies also have expertise in analyzing the results. In any case, all of the above-mentioned methods of monitoring exposure are acceptable and, when properly documented, will serve to indicate that a facility has met the standards.

Waste Anesthesia Gases Waste anesthesia gases (WAGs), although not yet covered by federal regulations, have long been recognized as health hazards to operating room personnel. Many materials are used at the same time to anesthe- tize patients, but for ease of monitoring, the nitrous oxide component of anesthetic gas mixtures is generally regarded as the indicator; that is, if the levels of nitrous oxide are below 25 ppm TWA, it is assumed that the levels of other materials are acceptable.

Again, dosimeters and badges are one method of effective monitoring, and direct-reading offers another approach. Each approach has its advantages and disadvantages.

WAGs must be controlled and monitored under a program accountable to the facility’s overall program for handling hazardous materials and wastes (see also the Introduction and Chapter 2, page 11). An effective WAG program might include a preventive maintenance procedure such as the following:

Check each anesthesia machine regularly and after ~~~~ ~


Method for MonitorinR Hazardous Gases and Vapors

any repair or modification; assure that it does not leak excessive amounts of material. Set the anesthesia machine up in the operating room, with the scavenging system (the system for collecting WAGs and removing them from the room) attached; test it with a dummy lung to assure the WAG scavenging system is effective. Monitor room air during actual operating room procedures to assure that the levels of WAGs in the air are low enough to be nonhazardous.

The WAG program may not have to be elaborate, and if maintenance is performed by contract with an outside agency, the agency may be considered legally responsible for conducting such a program, or at least partly responsible for conducting it. To document compliance with JCAH standards, however, some effective WAG monitoring program should exist.

Formaldehyde and Xylene Laboratories, too, contain a variety of potential hazards that may be identified and may need monitoring. Examples of materials used in many facility laboratories are formaldehyde (HCHO) and xylene. Formalde- hyde, which is an irritating gas and a suspected car- cinogen, is used as a tissue preservative. It is used in the form of formalin, an aqueous solution of the gas in water, and has a TWA of 3 ppm. One ppm will irri- tate most people’s eyes and, in fact, many hospitals have decided that 0.2 ppm is the acceptable limit based on the comfort of their personnel. Xylene, a hy-

drocarbon, is used to process tissue for water removal in preparation for embedding the tissue in paraffin. It is flammable, is explosive in some mixtures, and may cause liver and kidney damage. Its TWA is 100 ppm.

All these known hazards and others more specific to certain types of facilities-such as ozone from ionizing and high-voltage sources, or contaminated air that is recirculated in an airtight building-should be monitored if present in the workplace. Control measures may reduce the hazards, but to assure that the control measures work, monitoring for gases must still be performed regularly.

Conclusion Even where state or local laws do not specifically require facilities to establish a program to monitor and control hazardous gases and vaporous materials, they at least imply that such a program should exist. It is an effective method of demonstrating compliance with JCAH standards concerning the use and disposal of hazardous gases and vapors. Such a program also strengthens the facility’s overall program for reducing hazards and preventing emergencies from occurring.

The program for minimizing risks can also be strengthened by properly tracking and documenting the movement of all hazardous materials as they are received, used, produced, or disposed of in various departments throughout a facility. Chapter 8 discusses basic steps toward identifying the flow of hazardous materials with the use of written records and self- survey documents.


Chapter 8 Hazardous Materials and Wastes Program: Documentation

To comply with federal and local regulations, and to be able to demonstrate the appropriateness of your program for handling and disposing of hazardous materials and wastes, documentation is necessary.

Several categories of documentation should be available for review by a facility’s safety committee: policies and procedures manuals; a written description of a program for the inventory and tracking of hazardous materials and wastes; permits, manifests, and other handling documents; and reports of hazard surveys, purges, and similar types of inspections that are conducted as part of the safety committee’s hazard surveys. The facility’s overall hazardous materials and wastes program should also be reviewed annually by the appropriate committees, such as the radiation safety committee, the infection control committee, the pharmacy committee, and the safety committee.

As explained in Chapter 4, an inventory and tracking program is necessary to allow facility staff to find and keep track of all the hazardous materials and wastes on facility grounds. The program itself must be described in writing, must be approved by the facility’s safety committee, and should be practical and realistic. The written description should be checked against what is really being done. If it is evident that the system as described in writing is not being followed, either facility policies or the procedures must be changed.

The methods used in a facility to store and transport hazardous materials and wastes should be explained in a written description of systematic policy and procedure and should be inspected regularly. Such documentation and inspection should be part of the facility’s overall program for handling and monitoring hazardous materials and wastes. Surveys conducted under the hazard surveillance system should be conducted regularly-at least quarterly-and should include inspection of the storage areas and areas where hazardous materials are used; ventilation should be inspected, and amounts of hazardous material kept available for use should be documented. The survey should include a search for areas within a facility that have not yet been identified by the facility’s overall waste-handling program as areas where hazardous materials are used. Inspectors should also check to see

whether personal protective equipment is available and is being used.

A program for training all users of hazardous materials and personnel who are responsible for handling or managing materials and wastes should be explained in a written description of systematic policy and procedure. The training program described in the document should also be reviewed to assure that the instruction reflects activities that will actually be carried out in the workplace and to assure that all appropriate personnel are trained for the role they fill in the procedures to be followed.

Facilities should have permits and manifests concerning all hazardous wastes shipped for disposal. There should be a written list that describes those methods of waste disposal, destruction, or elimination that are used on-site, if such a written list is required by federal, state, or local regulations and authorities. The filed permits, manifests, and documents should be revised on a quarterly basis by facility staff. It may also be useful to record the following: amounts of hazardous materials that are received by the facility and to what departments or services they are distributed; amounts of hazardous wastes that are picked up for disposal and what departments or services are disposing of them; and some method of accounting for dif- ferential amounts.

Conclusion With the use of appropriate documentation, a facility not only can demonstrate compliance with JCAH standards but also can lower the risk that emergencies of an unknown nature could occur. Systematic documentation concerning all hazardous materials and wastes in a facility helps assure that a maximum number of potential hazards are recognized and under- stood in advance.

No system is without risk, however; wherever hazardous materials of any kind are used, the chance of accident always exists. A facility must be ready to respond to all possible emergencies. Chapter 9 discusses steps toward developing an effective emergency response plan for each area in which accidents involving hazardous materials and wastes could occur.


i

Chapter 9 Developing an Emergency Response Plan

Any facility that uses hazardous materials (which is almost every type of health care facility) must design an emergency response plan appropriate for the type, quantity, and severity of the hazards faced. If a facility uses only a small quantity of hazardous materials, such as housekeeping supplies and maintenance supplies, the plan does not need to be complex. Even these materials, however, need attending to, and appropriate plans should be made for spills and leaks. Large institutions with extensive laboratories and treatment areas require much more sophisticated plan- ning and more extensive employee education and preparation.

The first step in preparing an effective emergency response plan is to develop an inventory of all hazardous materials and wastes that pass through a facility (see Chapter 4) . Knowing what hazards exist will enable an assessment to be made of the need for equipment, training, and drills. This chapter discusses three essential elements in an effective emergency response plan: the availability of hazard containment, cleanup, and personal protective equipment; the training of all employees in proper responses to all possible types of emergencies; and regular drills to assure that employees are familiar with actions to take during an actual emergency.

Equipment As part of an effective emergency response plan, certain pieces of equipment are immediately available at the site and time at which an emergency could occur. The equipment is intended to enable staff in the immediate area to minimize and contain hazards in the quickest possible time after an accident (usually a spill, leak, or uncontrolled chemical reaction) occurs. Thus, a basic kit of safety equipment should be available in each area in which hazardous materials are in use. Such a kit, usually called a “spill kit,” although it is often known commercially as a “response kit,” does not have to be expensive and sophisticated. A spill kit can contain such simple materials as commercial spill absorbents or even kitty litter (clay) or ver- miculite (expanded mica). The material should be chemically inert-sawdust , for example, could catch fire and so should not be used. Wherever materials requiring a specific type of emergency handling are used or stored (eg, hydrofluoric acid), appropriate absorbents or neutralizers should be included in the spill kit.

More equipment than that contained in a spill kit may be necessary for an adequate response to some emergencies. The more elaborate equipment should be

at a central location in the facility so that staff in any area can use it to gain control of a spill, leak, or reaction; neutralize harmful material; clean up the area; and test to assure that all contamination is gone. The additional equipment may include explosion-proof exhaust fans to evacuate hazardous or irritating vapors or gases. A “wet vac” type of vacuum system may be necessary to collect the neutralized materials and pick up the neutralizing materials. Scoops, shovels, squeegees, plastic bags, and buckets will almost cer- tainly be needed, as will a variety of materials appropriate for the various potential hazards identified in a facility.

As a general rule, tHe response to a spill of a hazardous material is as follows:

Evacuate the personnel in the area. Put absorbent from the spill kit on the material if the material spilled is in liquid form (and if this can be done safely). Call in trained, protected people to assess the hazard. Take appropriate action to remove the hazard.

After the main hazard is eliminated, cleanup equipment will then be needed. Cleanup equipment should also be available from the central location for emergency response equipment and should include squeegees and scoops, usually of an inert plastic. In addition, cleanup equipment should include disposal containers appropriate for the method of disposal chosen; for example, cardboard boxes and plastic liners are appropriate if the contaminated materials are to be incinerated, and plastic-lined metal containers may be appropriate for landfill disposal. A supply of heavy- duty plastic bags should be available for general uses. These general uses include containment of hazardous materials, particularly leaking containers, and isolation of contaminated equipment until i t can be cleansed. The plastic bags can also be used to line containers for the collection of used absorbents and neutralizers. Plastic sheeting can be used to cover floors and to seal doorways, windows, and in some cases, corridors; corridors may need to be sealed to control ventilation using plastic or duct tape, or a similar wide adhesive or fiber tape. Barrier tape, crepe paper, and warning signs may be necessary to define contaminated areas and keep people out.

Personal protective clothing, such as bonded olefine clothing (eg, Tyvek@), shoe protectors or boots, and appropriate gloves must be immediately available for personnel who must enter the area of a leak or spill to assess the problem. Ideally, supplied air or self-con-


Develobinn an Emergency Resbonse Pian

tained breathing apparatus (SCBA) should be available for personnel entering a contaminated area to assess the spill, respond to it, and clean up the area.

Commercial Versus Homemade Spill Kits There are several suppliers of commercial hazardous- materials response kits; in some institutions, commercial kits might be the best way to get the proper range of specizl equipment and materials needed. However, many facilities have the necessary materials at hand and need only to collect them and make them available during an emergency. Homemade spill kits have the virtue of being less expensive and more easily replaced than commercial kits and are usually adequate for most applications.

Personal Protective Equipment Personal protection for use during a hazardous materials incident must be immedjately available. As discussed in Chapter 6, personal protection has its disadvantages, but at the moment a spill, leak, or uncontrolled reaction occurs, personal protective equipment is the only practical method of protection. How- ever, the equipment chosen must be able to protect against a wide variety of hazards.

Gloves. Nitrile rubber gloves generally provide appropriate emergency protection against the widest range of hazards. Several pairs should be available in the response kit. The gloves should be tested peri- odically to assure they have not been damaged and do not have any leaks. Gloves are needed in almost every type of hazard response.

Eye and Face Protection. If respiratory protection is not used (and even if half-face respirators are used), face and eye protection are a must. Many kinds of equipment are available; at a minimum, chemical (splash-proof) goggles are needed, and in most cases, a full-face shield is better. The chance of contact from a splash of liquid or of particulate material is too great to allow full-face protection to be ignored. If SCBA is used, it will provide the necessary face protection.

Respiratoty Protection. If it is possible that hazardous particulates, vapors, or gases may mingle with the air, appropriate respiratory protection is needed. Where such exposures can be precalculated, such as in an ethylene oxide (ETO) release, chemical cartridge respirators may be sufficient. E T 0 release can be calculated by dividing the volume of E T 0 in tanks by the volume of the area where they are in use or storage. However, in a general response, where it will be difficult to know what the type and concentration of a hazard are, SCBA of the type used by fire fighters, which gives maximum possible protection against any exposure, should be immediately available. In emergency situations, SCBA should never be used by one person alone in the danger area. If a person wearing SCBA in the immediate vicinity of an emergency is incapacitated, persons in a safer area are left with the

uncomfortable decision of whether to leave the en- dangered person in trouble or risk other lives to rescue him. This problem is eliminated if at least two SCBA units are available in the emergency.

Whole-Body Protection. In some incidents, particularly where toxic or corrosive materials are spilled, those responding and cleaning up will need whole- body protection. Tyvek@-type jumpsuits (made of spun-bonded olefines) are often effective. In some cases, Tyvek@ shoe protectors similar to those used in the operating room will serve as shoe protection, if they are the nonporous type; if they are not available, suitable protective boots would be needed. Note that if leather materials (eg, shoes and belts) are contaminated by corrosives, they should be discarded because it is impossible to be sure that all the contamination is removed. The hazardous material may cause burns or a toxic reaction when the leather garments are worn later.

Personal protective equipment should be assembled and maintained in a location near the hazards or near the area of a facility in which response personnel are located. To start looking around for appropriate protection only when an incident involving hazardous materials occurs is totally inadequate.

Choice and procurement of personal protective equipment should be the responsibility of the facility’s safety officer or some other designated person, and the equipment should be checked regularly to assure its availability in emergencies. In many cases, such equipment should be enclosed in special boxes, as are fire extinguishers and similar emergency items.

Additionally, lists of other available equipment and sources of emergency supplies within the facility should be posted in each area in which such materials might need to be used. Lists of sources of outside assistance and experts may need to be immediately available in case the facility cannot handle a problem alone. It is also useful for facility staff to determine what assistance the local fire department can render and to acquaint the fire department with the facility’s system for controlling hazards and responding to emergencies. This way the fire department will have the information it needs to offer help in the event of an emergency.

Training Training is also an important element of the emergency response plan. Facility staff should implement at least general training of every employee who may handle or be involved in a hazardous materials incident. More comprehensive training should be provided for emergency response team personnel, if an emergency response team is a part of a facility’s emergency response plan.

The general training should include a description of the hazardous materials the employee will or may be exposed to and should describe the immediate stages of an emergency response. These stages generally in-

-


Developing an Emgency Rarponse Plan

clude using spill kits (employees must be told where to find them), evacuating and isolating the area, and alerting the emergency response personnel. Every employee using or working near hazardous materials should have this training.

To prepare more effectively for potential emergencies, some facility staff may be organized as a team to take specific actions during an emergency. Such a team, the “emergency response team,” should consist of two groups: (1) a smaller group of key personnel with a wide range of knowledge and training, who will direct other personnel during an emergency, and (2) a larger group of personnel who have been trained in the responsive actions to take during an emergency; this group will be supervised during the emergency by the key personnel. The key personnel should receive formal training in dealing with emergencies involving hazardous materials. Note that many such courses are designed for people who must take action during large-scale (eg, transportation) emergencies; courses on large-scale emergencies may not contain appropriate instruction for personnel needing to learn proper emergency response in a health care facility.

A course designed to instruct laboratory and other facility personnel in the management of chemical hazards and in methods of emergency response would be ideal for the facility managers and for safety personnel in laboratory areas, who would be members of the small group. Members of the emergency response team “large group”-such as laboratory managers, laboratory safety committee personnel, security personnel, maintenance personnel, and other types of personnel whose services are required 24 hours a day-should receive basic information about the types of hazardous materials in use in the laboratory. These personnel should be trained in the appropriate responses to the emergencies each type of material might cause. They should also learn about personal protection, emergency response equipment, management of an incident, and how to use a SCBA unit.

Each member of the small group should have a complete manual on policies and procedures for managing emergencies involving hazardous materials and should have access to the emergency equipment. Members of the small group are generally those who

oversee a facility program or services and whose services need to be available on the premises on a 24-hour basis. When an emergency occurs, one of the members of the small group should either take responsive action or be immediately available for information and assistance. Only personnel trained to use SCBA units should be asked to do so.

Drills As is true for personnel responsible for any systematic means of assuring emergency preparedness, the emergency response team must receive regular practice at taking the actions that would be necessary during an emergency. Formal drills and refresher training should be conducted on a regular basis. Small facilities, and those using few hazardous materials, may wish to count their drills, their formal training, and their emergency response plans as fulfilling JCAH standards asking for a disasterlemergency preparedness plan. Larger institutions may wish to use a hazardous materials drill as one of the two yearly drills requested by JCAH’s emergency preparedness standards.

Conclusion An effective emergency response plan should ensure that both equipment and staff experience are sufficient to minimize the chance that emergencies resulting from spills, leaks, or uncontrolled reactions of hazardous materials will cause damage or injury. The amount and even the type of hazardous material involved in such an emergency is usually unknown; thus, facility staff must implement methods of control and containment that would be effective for use in emergencies of any kind and degree of seriousness.

Emergencies, as well as programs to minimize the risks associated with hazardous materials and wastes, ”

are addressed not only by JCAH standards but also by federal regulations. Chapter 10 discusses some recent changes in federal laws concerning the use and disposal of hazardous materials and summarizes some new requirements concerning methods of preparing for emergencies.

35 Managing Hazardozls Wastes ana! Materials

Chapter 10 New Federal Regulations Concerning Hazardous Materials and Wastes

One result of the public’s awareness of hazardous waste problems is the proliferation of government agencies and of health laws that apply to health care facilities as well as other industries: the Occupational Safety and Health Administration (OSHA), the Envi- ronmental Protection Agency (EPA), the Resource Recovery and Conservation Act (RCRA), the Toxic Substance Control Act (TOSCA), clean air and water legislation, right-to-know laws, and others. These regulatory considerations create a stringent climate for most facilities and make it all the more necessary for health care facility administrators to consider the way their facilities handle wastes as well as the ways wastes might be handled differently.

Due consideration of regulations concerning a variety of hazardous materials, as well as the use of such documents as permits and manifests, are primary con- cerns of most health care facilities. This chapter discusses two particularly important new areas of federal regulations that will affect health care facilities-the Hazardous and Solid Waste Amendments of 1984 and OSHA’s “Hazard Communications, ” also called the “right-to-know laws.”

The Hazardous and Solid Waste Amendments of 1984 On November 8 , 1984, President Ronald Reagan signed the Hazardous and Solid Waste Amendments of 1984 (HSWA) into law.” A reauthorization of EPA’s 1980 Resource Conservation and Recovery Act, HSWA regulates even greater numbers and types of health care facilities than RCRA did, and it limits their options regarding disposal of some types of hazardous wastes.

Current EPA hazardous waste regulations remain fundamentally unchanged by the new legislation, but HSWA has reduced the amounts of hazardous waste facilities may dispose of without needing to complete a manifest; HSWA has also introduced other kinds of legal controls. (See the definitions of manifests and certificates of legal disposal on pages 11-12, Chapter 2 . ) Previously, for example, any facility disposing of less than 1,000 kilograms (2,200 pounds) of hazardous wastes per month was exempt from any of the provisions of RCRA. Under HSWA, however, all facilities that generate from 100 kilograms (220

“A copy of the bill may be obtained from the EPA central office in Washington, DC.

pounds) to 1,000 kilograms of hazardous wastes per month will fall under these regulations as of April 1, 1986. They will have to seek a permit, obtain a manifest for their wastes, and ship wastes only to licensed transport, storage, and disposal (TSD) sites.

Under HSWA, a0 facilities will have to certify, on each manifest they complete, that they have implemented a program to minimize the amount of waste they need to dispose of. Furthermore, all chemical wastes will have to be properly and adequately labeled, and transporters will not be permitted to accept wastes that have inadequate labels. The generator (ie, the facility and facility staff responsible for handling hazardous wastes) will also be required to assure that the wastes are in appropriate containers, and the transporters will not be permitted to accept any wastes unless the containers meet EPA and U.S. De- partment of Transportation standards. No free liquids (ie, liquids not confined within an inner container packaged in absorbent that fills an outer container or drum) may be shipped or landfilled, even if they are contained in an absorbent. An absorbent alone is not enough.

In addition, the transporter must assure that wastes are appropriately labeled, are accounted for by a manifest, have the proper waste-minimization certificate (ie, a statement that the facility has implemented a program to minimize the hazardous waste it must dispose of), and are directed to a specific TSD facility. As a result of these requirements, the disposal contractor or the generator must assure, before shipping, that the designated TSD site will accept the wastes before shipping. If this assurance is not given before shipping, the wastes will, under HSWA, have to be shipped back to the generator and be reshipped under a new manifest to an alternative site-at great expense.

HSWA will also eliminate landfill as a disposal option for certain classes of hazardous chemical wastes. After July 8, 1986, wastes containing even small amounts of arsenic, lead, mercury, selenium, polychlorinated biphenyls (PCBs), and halogenated materials, such as solvents, will be prohibited from being disposed of in landfills.

Health care facilities that may fall into the new class of regulated facilities (those that dispose of less than 1,000 kg of waste per month and thus were not previously under the regulations) should seek permits as early as possible. A permit application commonly takes as long as 90 to 120 days to process, and disposal contractors cannot accept wastes from facilities that do not have permits.

Key dates to be aware of include the following:


New Federal Regulations

August 5 , 1985 I Small-quantity generators must use manifests and must obtain permits. September 1, 1985. All generators must include a waste minimization certificate (ie, a certificate as-

should be protected under “Hazard Communications” and have mandated the development of standards concerning hazard communications that will apply to all employees not exempted from OSHA regulations.

suring that the facility has implemented a program to minimize the waste it needs to dispose of) with each manifest. September 1, 1985’. All permits issued after this date must include a written description of the facility’s waste minimization program. September 1, 1985. Disposal of bulk or noncon- tainerized wastes of any sort is no longer allowed in a chemical landfill. November 8, 1985. Disposal of bulk or noncon- tainerized liquid hazardous wastes is no longer allowed in any landfill. February 8, 1986. Regulations are in effect to minimize the disposal of containerized liquid hazardous waste (ie, liquid hazardous waste in a sealed drum), and of containerized liquid hazardous waste diluted in free liquids in landfills. March 31, 1986. Small-quantity generators (100 kg to 1,000 kg/month) will either be under new regulations or will be regulated by the same standards as those for large-quantity generators. April 1, 1986. RCRA provisions will begin to apply to all facilities that generate 100 kilograms (220 pounds) to 1,000 kilograms (2,200 pounds) of hazardous wastes per month. July 8, 1986. Land disposal of specific wastes, including metal and metal salts, low pH materials, PCBs, and halogenated organic materials will be prohibited. November 8, 1986. Disposal of solvent wastes, listed in the legislation, will be prohibited in landfills.

Hazard Communications There is a relativeiy new area of OSHA regulations ti- tled “Hazard Communications, ” which currently ap- plies only to those workers in chemicals and manufacturing areas in specific industries. # Recently, however, the courts have indicated that all employees

*“Hazard Communications” is reproduced in the Code of Federal Regulations and is also obtainable from the OSHA office in Wash- ington, DC, or from one of the regional OSHA offices.

Those standards have not yet been prepared, but i t seems certain that in the near future most employees not covered by current state right-to-know laws will be covered under “Hazard Communications. ”

The right-to-know laws, both for “Hazard Commu- nications’’ and in the state laws, contain the same provisions as JCAH’s hazardous materials and wastes standard. The right-to-know laws require that all employees who handle hazardous materials and wastes be trained to use and handle those materials. They must also be trained to recognize the symptoms that these hazardous materials and wastes may cause, and they must be trained to take appropriate first-aid and emergency measures in the event of accidental contact with or release of the material. Also, both the federal and state regulations require an inventory of all hazardous materials and the maintenance of a file of Ma- terial Safety Data Sheets for each material. Making an inventory of all hazardous materials will be a large un- dertaking for many facilities, but the results-protection of staff, patients, and the community-justify the effort.

Under the right-to-know laws, most facilities will have to consider more hazardous materials and wastes than they had to consider prior to the new laws; thus facility staff will have to extend their waste-handling programs into areas other than just the laboratories. Facilities in states that do not have right-to-know laws may wish to consider implementing the program defined by the federal standards before the regulations go into effect, to allow sufficient time to prepare.

Conclusion Facilities should review all federal, state, and local laws pertaining to hazardous materials and wastes both for guidance in handling hazardous materials and wastes and to avoid being penalized for inadequate compliance with those regulations that are enforced. Notice should especially be taken of all relevant new legislation. Early awareness of changes in existing regulations, such as the changes introduced by HSWA and the right-to-know laws, will give a facility adequate time to adjust to necessary changes.


Bibliography

Adams S: System tackles infectious waste problem. Hospitals 58(1):55, Jan 1, 1984.

Anderson JS: Total waste management system. Journal of Hospital Supply, Processing and Distribution 2( 6): 28-30, NovJDec 1984.

Bailey PM: The legal impact on waste disposal. Execu- tive Housekeeping Today 4(9): 18, Sep 1983.

Bellospirito F: Antineoplastic drugs. Professional Sani- tation Management 11(6):46-47, AprJMay 1984.

Bellospirito F: Hazardous waste management. Profes- sional Sanitation Management 12(3):28-29, OctlNov 1984.

Berkow R, ed: Merck Index, 14th ed. Rahway, NJ: Merck Sharp & Dohme Research Laboratories, 1982.

Bleckman J: Hazardous Waste Management. Chicago: Society for Hospital Engineering and American Hospital Association, 1983.

Bleckman J: Support Services: Most radioactive wastes can be disposed of on-site. Hospitals 58(9):66, May 1, 1984.

Bond RG, Michaelson GS, DeRoos RL, eds: Environ- mental Health and Safety i n Health Care Facilities. New York: MacMillan Publishing Co, 1973.

Browes A: What is hospital waste? Hospital Engineering 37(9):13-14, Nov 1983.

Chamberlain CT: Energy recovery from the burning of hospital waste. Hospital Engineering 37( 10): 13-22, Dec 1983.

Chamberlain CT: Modern approaches to incineration practice. Hospital Engineering 37(9):4- 10, Nov 1983.

Crow S: Disposable needle and syringe containers. In- fection Control 6( 1):4 1-43, Jan 1985.

Falck S: Low-level waste sites: States juggling a hot potato. Applied Radiology 13( 1):76-79, JanlFeb 1984.

Ginsberg M: Sterilization: An efficient way to dispose of infectious waste. Executive Housekeeping Today 4(9):10, 23, Sep 1983.

Glorney M: Down in the dumps. Health G Social Sew- ice Journal 93(4870): 1290, Oct 27, 1983.

Harris RH, English CW, Highland JH: Hazardous waste disposal: Emerging technologies and public policies to reduce public health risk. Annual Review of Public Health 6( 1):269-294, 1985.

Hawley G: Condensed Chemical Dictionary, 10th ed. New York: Van Nos Reinhold Co, 198 1.

Kensett RG: The disposal of hospital waste. Hospital Engineering 39(3):4-8, Mar 1985.

Kortus D, Baumez R: Pyrolytic incineration: It can save your hospital energy and money. Journal of Hospital Supply, Processing and Distribution 2( 3): 38-40, MayJJun 1984.

Larson RL, Manni JR: Noncutting method of needle and s y r i n g e d i s p o s a l . H o s p i t a l Pharmacy 19(9):616-618, Sep 1984.

Mayworm D: In-service: ET0 Sterilization. Jownal of Hospital Supply, Processing and Distribution 2(4): 73-76, JulIAug 1984.

Merckel L: Where will all the garbage go? Health Care 27(2):32-35, Mar 1985.

Meyer E: Chemistry of Hazardous Materials. Englewood Cliffs, NJ: Prentice-Hall Inc, 1977.

National Research Council: Prudent Practices for Dis- posal of Chemicals from Laboratories. Washington, DC: National Academy Press, 1983.

National Research Council: Committee on Hazardous Substances in the Laboratory: Prudent Practices for Handling Chemicals in Laboratories. Washington, DC: National Academy Press, 198 1.

Nuclear Regulatory Commission: Code of Federal Regulation, as printed in the Federal Register. Washington, DC: Superintendent of Documents.

Occupational Safety and Health Administration: Reg- ulations, part 1910 as printed in the Federal Regis- ter. Washington, DC: Superintendent of Docu- ments.

Philip PC, Jayaraman S, Fister JP: Environmental impact of incineration of low-level radioactive waste generated by a large teaching medical institution. Health Physics 46(5): 1123-1 126, May 1984.

Printup RH: How to handle special waste control problems. Executive Housekeeping Today 5(9): 12- 15, Sep 1984.

Sax NI, Feiner B: Dangerous Properties oflndustrial Ma- terials, 6th ed. New York: Van Nos Reinhold Co, 1984.

Southam N: Disposing of hospital waste. Hospital De- velopment 11(7):25-26, Sep 1983.

Stellman JM, Aufiero BM, Taub RN: Assessment of potential exposure to antineoplastic agents in the health care setting. Preventive Medicine 13(3): 245-255, May 1984.

Stolar MH, Power LA: Safe handling of cytotoxic drugs in hospitals. Quality Review Bulletin lO(7): 209-213, Jul 1984.

~


Biblioarabh y

Stolar MH, Power LA, Viele CS: Recommendations for handling cytotoxic drugs in hospitals. American Journal of Hospital PhamCY 40(7): 1163-1171, JUl 1983.

Waterson CK: Recovery of waste anesthetic gases. Contemporary Anesthesia Practice 8: 109- 124, 1984.

Wright MR: Safety and the environmental issues with waste disposal in hospitals. Hospital Engineering 37 (9): 10-12, NOV 1983.


Appendix A JCAH Standards on the Management of Hazardous Materials and Wastes

This appendix lists the standards contained in each of JCAH’s standards manuals that pertain to programs for controlling the risks involved in handling hazardous materials and wastes.

Accreditation Manual for Hospitals (1986 edition)

Chapter 1: Anesthesia Services

Standard 1.3 Precautions are taken to assure the safe administration of anesthetic agents.

Required Characteristics 1.3.3.1 Anesthetic apparatus is inspected and tested by the anesthetist before use.

1 .3 .3 .1 .1 If a leak or any other defect is observed, the equipment is not used until the fault is repaired.

Standard 1.4 There are written policies that relate to the delivery of anesthesia care.

Required Characteristics 1.4.1.1.1.3.1.3 Each anesthetic gas machine has a pin-index safety system.

1 . 4 . 1 . 1 . 1 . 3 . 1 . 3 . 1 I t is recommended that each machine also be provided with a gas-scavenging system and an oxygen-pressure interlock system.

Chapter 2: Dietetic Services

Standard 2.2 Dietetic services personnel are prepared to conduct their assigned responsibilities through appropriate orientation, education, and training.

Required Characteristics 2.2.3 As appropriate to their level of responsibility, new personnel receive instruc-

tion and demonstrate competence in the following:

2.2.3.5 The proper method of waste disposal;

Standard 2.4 The dietetic department/service is designed and equipped to facilitate the safe, sanitary, and timely provision of food service to meet the nutritional needs of patients.


Appendix A

Required Characteristics 2.4.3 The following sanitation precautions are taken in the handling and prepara-

tion of food:

2.4.3.12 Garbage is held, transferred, and disposed of in a manner that does not create a nuisance or a breeding place for insects, rodents, and vermin or otherwise permit the transmission of disease.

2.4.3.12.1 Garbage containers are leakproof and nonabsorbent with close- fitting covers.

Chapter 3: Emergency Services

Standard 3.5 Emergency patient care is guided by written policies and procedures.

Required Characteristics 3.5.1.2 The policies and procedures in Level I, Level 11, and Level I11 emergency de-

partmentdservices and, as appropriate, in Level IV emergency departments/ services relate to at least the following:

3.5.1.2.10 Pertinent safety practices.

Chapter 4: Governing Body

Standard 4.3 All members of the governing body understand and fulfill their responsibilities.

Required Characteristic 4.3.2 All members of the governing body are provided information relating to the

governing body’s responsibility for quality care and the hospital’s quality assurance program.

Chapter 6: Hospital-Sponsored Ambulatory Care Services

Standard 6.3 The provision of ambulatory care services is guided by written policies and procedures.

Required Characteristics 6.3.4 The policies and procedures relate to at least the following:

6.3.4.10 Infection control measures.

6.3.4.11 Pertinent safety practices.

Chapter 7: Infection Control

Standard 7.1 There is an active, effective, hospitalwide infection control program.


Appendix A

Required Characteristics 7.1.2 The basic elements of the infection control program include the following:

7.1.2.5 Preventive, surveillance, and control procedures that relate to the in- animate hospital environment, including sterilization and disinfection practices, central services, housekeeping, laundry, engineering and maintenance, food sanitation, and waste management.

7.1 .2 .5 .1 Such procedures are evaluated on a continuing basis and revised as necessary.

7.1.3 An effective hospitalwide infection control program also includes other elements that may be implemented to varying degrees depending on the hospital and the services provided.

7.1 .3 .1 These elements include, but need not be limited to, the following:

7 . 1 . 3 . 1 . 5 Consultation regarding the purchase of all equipment and supplies used for sterilization, disinfection, and decontamination purposes;

7 . 1 . 3 . 1 . 9 The evaluation of hospital disposal systems for all liquid and solid wastes.

Standard 7.2 Responsibility for monitoring the infection control program is vested in a multidisciplinary committee.

Required Characteristics 7.2.1 The infection control committee is a hospitalwide committee.

7.2 .1 .1 The infection control committee function may be performed by the medical staff if

7.2 .1 .1 .1 representatives of other professional disciplines and the administration participate.

Standard 7.3 There are specific written infection control policies and procedures for all services throughout the hospital.

Required Characteristics 7.3.3 The written policies and procedures are developed in cooperation with the fol-

lowing departmentslservices and areas:

7.3 .3 .1 1 The pathology and medical laboratory services.

7.3.3.1 1 . 1 Specific policies and procedures relate to the handling and disposal of biological waste.

Standard 7.6 The laundry service is provided with adequate direction, staffing, and facilities to perform all required functions.

Required Characteristics 7.6.4 Soiled linen is collected in such a manner as to minimize microbial dissemina-

tion into the environment.


Appendix A

7.6.4.1 Such linen is placed in a bag or other container of sufficient quality to functionally contain wethoiled linen during the time required to collect or remove it from the patient care area, without contaminating the patient environment.

7.6.8 Soiled linen from isolation areas and septic surgical cases is identified, and suitable precautions are taken in its subsequent processing.

Chapter 8: Management and Administrative Services

Standard 8.1 The hospital is managed effectively and efficiently.

Required Characteristics 8.1.4 The chief executive officer, through the management and administrative staff,

provides for the following:

8.1 .4 .2 The implementation of organized management and administrative functions throughout the hospital, including the establishment of clear lines of responsibility and accountability within departmentdservices and between departmendservice heads and administrative staff.

8 . 1 . 4 . 4 The implementation of effective communication mechanisms between and among hospital departmentdservices, the medical staff, the administration, and the governing body.

Chapter 10: Medical Staff

Standard 10.6 As part of the hospital’s quality assurance program, the medical staff strives to assure the provision of quality patient care through the monitoring and evaluation of the quality and appropriateness of patient care. Opportunities to improve patient care also are addressed.

Required Characteristics 10.6.1 The medical staff provides effective mechanisms to monitor and evaluate the

quality and appropriateness of patient care and the clinical performance of all individuals with delineated clinical privileges. Important problems in patient care are identified and resolved, and opportunities to improve care are addressed, through the functions listed in Required Characteristics 10 .6 .1 .1 through 10.6.1.7.3.2 of this standard.

10.6.1.7.1 The medical staff participates in other review functions, including infection control, internal and external disaster plans, hospital safety, and utilization review.

Chapter 11: Nuclear Medicine

Standard 1 1.3 Nuclear medicine activities are governed by quality-control policies and procedures that assure diagnostic and therapeutic reliability and safety of patients and personnel.


Appendix A

Required Characteristics 1 1.3.2 When required by applicable law or regulation, by licensure requirements, or

by the medical staff, a radioisotope committee is established.

1 1.3.2.5 The committee concerned with nuclear medicine activities has at least the following responsibilities:

1 1.3.2.5.3 To develop regulations for the use, transport, storage, and disposal of radioactive materials used in nuclear medicine procedures.

11.3.4 Policies and procedures relating to safety within the nuclear medicine services areas are developed and enforced.

11.3.4.1 These policies and procedures include, at a minimum,

11 .3 .4 .1 .2 guidelines to be followed in the event of radioactive contamination of personnel, equipment, or environment.

Chapter 13: Pathology and Medical Laboratory Services

Standard 13.2 There are sufficient space, equipment, and supplies within the pathology and medical laboratory services to perform the required volume of work with optimal accuracy, precision, efficiency, timeliness, and safety.

Required Characteristics 13.2.2 The laboratory environment is conducive to the optimal performance of per-

sonnel and equipment.

13 .2 .2 .1 The ventilation system provides an adequate amount of fresh air and can remove toxic and noxious fumes.

Standard 13.5 Quality-control systems and measures of the pathology and medical laboratory services are designed to assure the medical reliability of laboratory data.

Required Characteristics 13.5.3 General quality controls required of and practiced by the pathology and medi-

cal laboratory services include, but need not be limited to, the following:

13.5.3.13 Labeling of reagents and solutions for identity, strength, caution- arylaccessory information, and preparation and expiration dates, as appropriate.

Chapter 14: Pharmaceutical Services

Standard 14.2 Space, equipment, and supplies are provided for the professional and administrative functions of the pharmaceutical departmentlservice as required to promote patient safety through the proper storage, preparation, dispensing, and administration of drugs.

Required Characteristics 14.2.2 Drug storage and preparation areas within the pharmacy and throughout the


hospital are under the supervision of the director of the pharmaceutical departmendservice or his pharmacist-designee.

14.2.2.4 The director of the pharmaceutical departmendservice or his qualified designee conducts at least monthly inspections of all nursing care units or other areas of the hospital where medications are dispensed, administered, or stored.

14.2.2.4.1 A record of all such monthly inspections is maintained to verify that the following requirements are met:

14.2.2.4.1.3 Outdated or otherwise unusable drugs are identified, and their distribution and administration are prevented.

14.2.2.4.1.3.1 The director of the pharmaceutical departmentlservice, with the approval of the chief executive officer, designates one or more areas for the authorized storage of such drugs prior to their proper disposition.

Chapter 15: Plant, Technology, and Safety Management

Standard: Hazardous Materials and Wastes 15.6 There is a system that is designed to safely manage hazardous materials and

wastes.

Required Characteristics 15.6.1

15.6.2

15.6.3

15.6.4

15.6.5

15.6.6

15.6.7

The hazardous materials and wastes management system addresses the management of hazardous materials and wastes from the point of entry into the hospital to the point of final disposal.

The hazardous materials and wastes management system addresses the protection of patients, personnel, visitors, and the community environment.

Policies and procedures are developed that include a process for identifying hazardous materials and wastes (eg, toxic materials, infectious wastes, radioactive materials) and for managing them using techniques such as substitution of less hazardous agents, changes of processes, isolation, and ventilation.

Policies and procedures relating to the operation of the hazardous materials and wastes management system are reviewed at least annually by the safety committee for chemical and physical hazards, by the infection control committee for infectious hazards, and by the radiation committee for radioactive hazards.

15.6.4.1 Recommendations, conclusions, and actions of these committees are reported to the hospitalwide quality assurance function.

Individuals required to handle hazardous materials or wastes are provided with appropriate job training.

The hazardous materials and wastes management system includes a program for controlling the handling and disposal of gaseous hazardous materials.

15.6.6.1 Included in this program are procedures pertaining to the control of waste gas levels in areas such as surgical suites, central supply, and laboratories.

The hazardous materials and wastes management system includes a program for controlling the handling and disposal of liquid and solid hazardous materials.

~~~~


Appendix A

15.6.8

15.6.9

15.6.10

15.6.7.1 Included in this program are procedures pertaining to the elimination of hazards through the elimination and treatment of the waste at the source, the packaging of the waste, safe transport systems within the hospital, and adequate and safe disposal facilities either on-site or off-site.

The hazardous materials and wastes management system is established and operated in accordance with applicable law and regulation.

Compliance with the JCAH hazardous materials and wastes management standard does not relieve the facility of the responsibility to comply with applicable federal, state, and local codes.

All components of the waste management system, including transport systems, storage areas, and treatment facilities, are subject to safe and sanitary practices.

15.6.10.1 Such practices include prevention of contamination of patient- care, food-preparation, and serving areas by waste-compaction and storage areas.

Chapter 17: Quality Assurance

Standard 17.2 The scope of the quality assurance program includes at least the activities listed in Re- quired Characteristics 17.2.1 through 17.2.5.3 and described in other chapters of this Manual.

Required Characteristics 17.2.3 The following hospitalwide functions are performed:

17.2.3.3 Review of accidents, injuries, and safety hazards (Plant, Tech- nology, and Safety Management, Standard 15.3, Required Characteristics 15.3.1.3and 15.3.1.3.1).

Chapter 18: Radiology Services

Standard 18.3 There are written policies and procedures, including safety rules, for the radiology departmendservice.

Required Characteristics 18.3.3.10 Radiation safety precautions include provision for at least the following:

18.3.3.10.3 Rules for the safe use, removal, handling, and storage of radi- um, other radioactive elements, and their disintegration products.

Chapter 20: Respiratory Care Services

Standard 20.3 Respiratory care services are guided by written policies and procedures.


Appendix A

Required Characteristics 20.3.2 The written policies and procedures relate to at least the following:

20.3.2.4 The procurement, handling, storage, and dispensing of therapeutic gases.

20.3.2.5 Pertinent safety practices, including the control of electrical, flammable, explosive, and mechanical hazards.

Chapter 22: Special Care Units

Standard 22.7 Specific-purpose special care units may be established as determined by the patient needs of the community and only as supported by the resources available to the hospital.

Required Characteristics 22.7.2 Burn Unit.

22.7.2.6 Policies and procedures related to decreasing the risk of infection through indirect cross-contamination and direct transfer of infection are implemented.

22.7.2.6.1 Such policies and procedures relate to at least the following:

22.7.2.6.1.5 Solid and liquid waste systems.

Managing Hazardom Wasto and Materials 48

Abbendh A

Ambulatory Health Care Standards Manual (1986 edition)

Chapter 6: Administration

Standard 6.1 The organization is administered in a manner that promotes the provision of high-quality health care services and fulfills the organization’s mission, goals, and objectives.

Required Characteristics 6.1.1 Administrative policies, procedures, and controls are established, imple-

mented, and reviewed at least annually to promote the orderly and efficient management of the organization.

6 .1 .1 .1 These policies, procedures, and controls address at least the following:

6.1.1.1.9 Controlling the purchase, maintenance, and distribution of the equipment, materials, and facilities of the organization.


Standard 7.1 The organization provides a safe environment for patients, personnel, and visitors.

Required Characteristics 7.1.2 There is a program that is designed to provide a safe environment for pa-

tients, personnel, and visitors and to monitor that environment.

7.1.2.1 The program addresses at least the following:

7.1.2.1.1 The reporting of all accidents, injuries, and safety hazards.

7.1.2.1.2 The provision of safety-related information to be used in the education of all employees.

7 . 1 . 2 . 3 There is evidence that the conclusions, recommendations, and actions of the safety program are evaluated by the appropriate administrative di- rectors of the areas affected.

7.1.2.6 The space allocated for a particular function or service is adequate for the activities performed therein.

7.1.3 The organization has an emergency preparedness program designed to provide for the effective utilization of available resources so that patient care can be continued during a disaster.

7 .1 .3 .1 Concise, documented plans to be implemented during a disaster are established through the emergency preparedness program.

7 .1 .3 .1 .1 Emergency preparedness plans are pertinent to a variety of disasters and are based on the organization’s capabilities and limitations.

7.1.4 There is a system that is designed to safely manage hazardous materials and wastes . 7 .1 .4 .1 The system includes policies and procedures for identifying, packaging, handling, and disposing of hazardous materials and wastes.


Abbendix A

7.1.4.2 The system is established and operated in accordance with federal, state, and local regulations.

7.1.4.3 All components of the waste-management system, including transport systems, storage areas, and treatment facilities, are subject to safe and sanitary practices.

Chapter 8: Educational Activities

Standard 8.1 The organization strives to improve the professional competence and skill, as well as the quality of performance, of the health care practitioners and other professional personnel it employs.

Required Characteristic 8.1.2 The organization provides adequate orientation and training to familiarize all

personnel with the organization’s facilities and procedures.

Chapter 9: Surgical and Anesthesia Services

Standard 9.1 When surgical or anesthesia services are provided by the organization, they are provided in a safe environment and are performed by qualified health care practitioners who have been granted privileges by the governing body to perform these services.

Required Characteristics 9.1.22 A safe environment for treating surgical patients, including adequate safe-

guards to protect the patient from cross-infection, is provided.

9.1.22.1 As evidence of a safe environment, at least the following requirements are met:

9.1.22.1.1 Appropriate space and equipment are present.

Chapter 11: Pathology and Medical Laboratory Services

Standard 11.1 Pathology and medical laboratory services provided or made available by the organization are designed to meet the needs of patients and are provided in accordance with professional practices and legal requirements.

Required Characteristic 11.1.6 Established procedures are followed in obtaining, identifying, storing, and

transporting specimens.

Managing Hazardous Wastar and Materials 50

Appendix A


Standard 12.1 Radiology services provided or made available by the organization are designed to meet the needs of patients and are provided in accordance with professional practices and legal requirements.

Required Characteristics 12.1.7 Policies and procedures address the safety and quality aspects of radiology

services.

12.1.7.1 These policies and procedures include, but need not be limited to, the following:

12.1.7.1.3 Regulating the use, removal, handling, and storage of any radioactive material.

12.1.8 Adequate space, equipment, and supplies are provided for performing the volume of work with optima1 accuracy, precision, efficiency, and safety.

12.1.8.1 Specific safety factors include, but need not be limited to,

12.1.8.1.5 instructions to personnel in safety precautions and in the handling of emergency radiation hazards.

51 Managing Hazardous Wastes and Materiah

Abbendix A

Consolidated Standards Manual for Child, Adolescent, and Adult Psychiatric, Alcoholism, and Drug Abuse Facilities and Facilities Serving the Mentally Retarded/ Developmentally Disabled (1985 edition)

Chapter 20: Anesthesia Services

20.2 Because individuals with varying backgrounds may administer anesthetic agents, the professional staff must approve written policies on anesthesia services and document their enforcement.

20.2.5 The policies shall require the anesthetist to check, prior to the administration of anesthesia, the readiness, availability, cleanliness, and working condition of all equipment used in the administration of anesthetic agents.


22.15 The dietetic service shall have policies governing the handling and preparing of foods.

22.15.8 Garbage shall be held, transferred, and disposed of in a manner that does not create a nuisance, permit the transmission of disease, or create a breeding place for insects or rodents.

22.15.9 Garbage containers shall be leakproof and nonabsorbent and have close- fitting covers.

Chapter 25: Pathology and Laboratory Services

25.6 Work areas in the laboratory shall be arranged to minimize transportation and communication problems and should be adequately lighted to facilitate accuracy and precision.

25.6.4 Special precautions should be taken to avoid physical, chemical, and biological hazards.


28.4 The radiology service shall prvvide appropriate facilities for radiographic and fluoroscopic diagnostic services.

28.4.3 All personnel shall be given instruction in safety precautions and in dealing with emergency radiation hazards.

Chapter 3 1: Plant, Technology, and Safety Management

31.3 The facility has a system that is designed to provide a safe environment for patients, personnel, and visitors, and is designed to monitor that environment.

Managing Hazardoas Wastes and Materials 52

Appendix A

3 1.3.1 The system addresses at least the following:

3 1.3.1.2 The promotion and maintenance of an ongoing, facilitywide hazard surveillance program to detect and report all safety hazards related to patients, visitors, and personnel.

3 1.3.1.3 The reporting of all accidents, injuries, and safety hazards.

3 1.3.1.4 The provision of safety-related information to be used in the orientation of all new employees and in the continuing education of all employees.

3 1.3.1.5 Methods for monitoring the results of the safety program (see Standard 3 1.3.2) and for analyzing the program at least annually.

31.3.2 There is a multidisciplinary safety committee whose membership includes individuals qualified by training and/or experience to develop, implement, and maintain a comprehensive facilitywide safety program. Individuals with expertise in all areas of concern are included on the committee or are available to participate as needed.

There is evidence of information exchange and consultation between the safety committee and the various safety programs (for example, safety programs for engineering and maintenance, housekeeping, laboratory, nursing, and dietetic services), the infection control committee, the facilitywide quality assurance function, and other standing committees.

3 1.3.7

31.4 The facility has an organized safety education program.

31.4.1 There is documented evidence of a safety education program that includes orientation of new employees to general facilitywide safety practices, as well as orientation and continuing education regarding safety practices specific to individual departments or services.

Orientation and in-service education programs utilize findings of the quality assurance function, the safety committee, the infection control committee, and other appropriate standing committees.

3 1.4.2

31.5 The facility has an emergency preparedness program designed to provide for the effective utilization of available resources so that patient care can be continued during a disaster.

3 1.5.2 Concise, preestablished, documented plans to be implemented during a disaster are established through the emergency preparedness program.

31.5.2.2 Emergency preparedness plans are pertinent to a variety of disasters and are based on the facility’s capabilities and limitations.

31.6 There is a system that is designed to safely manage hazardous materials and wastes.

3 1.6.1 Policies and procedures are developed that include a process for identifying hazardous materials and wastes (for example, toxic materials, infectious wastes, radioactive materials) and for managing them using techniques such as substitution of less hazardous agents, changes of processes, isolation, and ventilation.

31.6.2 The system is established and operated in accordance with federal, state, and local regulations. Compliance with Standard 31.6 does not neces- sarily relieve the facility of the responsibility to comply with other applicable federal, state, and local codes.


Abbendix A

3 1.6.3 All components of the waste management system, including transport systems, storage areas, and treatment facilities, are subject to safe and sanitary practices. Such practices include prevention of contamination of patient care, food preparation, and serving areas by waste compaction and storage areas.

3 1.6.3.1 There are safety measures or devices to minimize risk of injury from trash compactors.

31.16 Where provided, medical gas systems are designed, installed, operated, and maintained in a manner that is designed to provide an adequate and safe supply of nonflammable medical gases for all required facility operations.

31.16.3 There are written procedures that specify the action to be taken during a failure of essential nonflammable medical-gas systems or equipment.

Managing Hazardous Wastar and Materials 54

Abbendix A

Long Term Care Standards Manual (1986 edition)

Chapter 1: Quality Assurance

Standard 1.2 The scope of the quality assurance program includes at least the activities listed in Required Characteristics 1.2.1 through 1.2.4 and described in other chapters of this Manual.

Required Characteristics 1.2.2 The following facilitywide functions are performed:

1.2.2.1 Infection control.


Standard 3.2 Dietetic services are supervised by a qualified dietetic services supervisor on a full-time basis.

Required Characteristics 3.2.1 Duties performed by the dietetic services supervisor include, but need not be

limited to, the following:

3.2.1.8 Provision for the safety and sanitation of all kitchen areas and equipment; in compliance with applicable standards.

Standard 3.7 Safe and sanitary practices are designed to assure safety and sanitation.

Required Characteristics 3.7.4 At least the following sanitation precautions are implemented in the dietetic

services area:

3.7.4.1 Garbage is held, transferred, and disposed of in a manner that does not create a nuisance or a breeding place for insects and rodents or otherwise permit the transmission of disease;

3.7.4.2 Garbage containers are leakproof and nonabsorbent and have close- fitting covers; and

3.7.4.3 Impervious plastic liners are used, if possible.

Chapter 5: InfectionlEnvironment Control

Standard 5.1 The facility endeavors to provide all services necessary to maintain a sanitary and comfort- able environment and to prevent the development and transmission of infection.

5s Managing Hazardous Wastes and Materials

Appendix A

Required Characteristics 5 .1 .5 The responsibilities of the infection control committee include, but need not

be limited to, the following:

5.1.5.5 Reviewing procedures for handling food, processing laundry, disposing of environmental and patiendresident wastes, controlling pests, and controlling the flow of internal traffic.

Standard 5.2 The facility employs a sufficient number of housekeeping personnel and endeavors to provide all equipment necessary for maintaining a clean, orderly, and safe environment.

Required Characteristic 5.2.5 The facility is free of insects and rodents.

Standard 5 .3 The facility has available, at all times, sufficient linen for the proper care and comfort of patientslresidents.

Required Characteristics 5.3.2 To guide personnel in the proper handling of laundry, procedures are devel-

oped for the following:

5.3.2.4 Proper sorting, handling, processing, and transporting of clean and soiled laundry.

Chapter 8: Medical Services

Standard 8.4 The facility has a medical director, full-time or part-time, to assure the adequacy and appropriateness of medical care provided to patientdresidents.

Required Characteristics 8.4.4 The duties and responsibilities of the medical director are delineated in a for-

mal agreement between the governing body and the medical director.

8.4.4.1 The agreement addresses the medical director’s responsibilities for at least the following:

8.4.4.1.15 To help assure a safe and sanitary environment for patientslresidents and personnel {by]

8.4.4.1.15.2 identifying hazards to health and safety.

Chapter 13: Pharmaceutical Services

Standard 13.4 Written policies and procedures serve as a guide to prescribing, dispensing, administer- ing, controlling, storing, and disposing of all drugs and biologicals in compliance with all applicable federal, state, and local laws and rules and regulations.


Abbendix A

Required Characteristics 13.4.15 There are written procedures for the proper disposition of all medications and

controlled drugs

13.4.15.1 on their expiration date;

13.4.15.2 on discharge or death of a patientlresident; and

13.4.15.3 upon discontinuation.


Standard 14.3 The facility has a system that is designed to provide a safe environment for patientslresidents, personnel, and visitors and to monitor that environment.

Required Characteristics 14.3.1 The system addresses at least the following:

14.3.1.2 The promotion and maintenance of an ongoing, facilitywide hazard surveillance program to detect and report all safety hazards related to patients1 residents, visitors, and personnel.

14.3.1.3 The reporting of all accidents, injuries, and safety hazards.

14.3.1.5 Methods for monitoring the results of the safety program (see Re- quired Characteristic 14.3.2) and for analyzing the program at least annually.

14.3.7 There is evidence of information exchange and consultation between the safety committee and the various safety programs (eg, safety programs for engineering and maintenance, housekeeping, laboratory, nursing, and dietetic services), the infection control committee, the facilitywide quality assurance function, and other standing committees.

Standard 14.4 The facility has an organized safety education program.

Required Characteristics 14.4.1 There is documented evidence of a safety education program that includes

14.4.1.1 orientation of new employees to general facilitywide safety practices; and

14.4.1.2 orientation and continuing education regarding safety practices specific to individual departments or services.

Standard 14.5 The facility has an emergency preparedness program designed to provide for the effective utilization of available resources so that patientlresident care can be continued during a disaster.

Required Characteristics 14.5.2 Concise, preestablished, documented plans to be implemented during a disas-

ter are established through the emergency preparedness program.


Appendix A

14.5.2.2 Emergency preparedness plans are pertinent to a variety of disasters and are based on the facility’s capabilities and limitations.

Standard 14.6 There is a system that is designed to safely manage hazardous materials and wastes.

Required Characteristics 14.6.1 The system addresses the management of hazardous materials from the point

of entry into the facility to the point of final disposal.

14.6.2 The system is established and operated in accordance with federal, state, and local law and regulation.

14.6.4 All components of the waste-management system, including transport systems, storage areas, and treatment facilities, are subject to safe and sanitary practices.

14.6.4.1 Such practices include prevention of contamination of patientlresident care, food preparation, and serving areas through waste compaction and storage areas.

Managing Hazardow Wastu and Materials 58

Appendix B Sample Material Safety Data Sheets

This appendix contains reproduced samples of material safety data sheets (MSDSs) used by actual manufacturing organizations for selected materials. The first MSDS in this appendix is the standard form that can be obtained from the Occupational Safety and Health Administration (OSHA) in Washington, DC,

or at one of the OSHA regional offices. The second MSDS is a form that an individual organization developed for its own use. This is often done. As this sample demonstrates, an MSDS developed by an organization must contain the same categories of information as those in the standard OSHA form.


US. DEPARTMENT OF LABOR Occupational Safety and Health Administration

I 1 ADDRESS (Number, Street, Cify, State, and ZIP Code) TRADE NAME AND SYNONYMS

MATERIAL SAFETY DATA SHEET

VEHICLE

SOLVENTS

ADDITIVES

I

METALLIC COATINGS

FILLER METAL PLUS COATING OR CORE FLUX

OTHERS

Requlred under USDL Safety and Health Regulations for Ship Repairing, I

~ ~~ ~ ~

HAZARDOUS MIXTURES OF OTHER LIQUIDS, SOLIDS, OR GASES

I Shipbuilding, and Shipbreaking (29 CFR 1915,1916,1917) I

TLC % (Units)

SECTION I MANUFACTURER’S NAME EMERGENCY TELEPHONE NO.

VAPOR PRESSURE (mm Hg.)

VAPOR DENSITY (AIR = 1)

PERCENT, VOLATILE BY VOLUME (%) EVAPORATION RATE ( = X)

CHEMICAL NAME AND SYNONYMS I

SECTION IV - FIRE AND EXPLOSION HAZARD DATA FLASH POINT (Method used) I FLAMMABLE LIMITS Ld Uel I I %

CHEMICAL FAMILY I FORMULA

I SECTION II - HAZARDOUS INGREDIENTS I

- ~

TLV PAINTS, PRESERVATIVES, & SOLVENTS I % I (Units) I ALLOYS AND METALLIC COATINGS I % I (Units) TLV

I PIGMENTS I I I BASE METAL I I I I I ALLOYS I I

I OTHERS I I I I I

SECTION 111 - PHYSICAL DATA BOILING POINT (“F.) I SPECIFIC GRAVITY (H?O=l) I

I SOLUBILITY IN WATER I I I I IAPPEARANCEANDODOR

~

I

I I I EXTINGUISHING MEDIA

SPECIAL FIRE FIGHTING PROCEDURES

UNUSUAL FIRE AND EXPLOSION HAZARDS

PAGE (1) (Contlnued on reverse slde) Form OSHA-20 Rev. May 72

Abbendix B

STABILITY

SECTION V - HEALTH HAZARD DATA THRESHOLD LIMIT VALUE

EFFECTS OF OVEREXPOSURE

MAY CAUSE SKIN IRRITATION.

EMERGENCY AND FIRST AID PROCEDURES

UNSTABLE CONDITIONS TO AVOID

STABLE

HAZARDOUS POLYMERIZATION

SECTION VI1 - SPILL OR LEAK PROCEDURES STEPS TO BE TAKEN IN CASE MATERIAL IS RELEASED OR SPILLED

MAY OCCUR CONDITIONS TO AVOID

WILL NOT OCCUR

WASTE DISPOSAL METHOD

LOCAL EXHAUST VENTILATION NORMAL MECHANICAL (General)

SPECIAL

OTHER

SECTION IX - SPECIAL PRECAUTIONS PRECAUTIONS TO BE TAKEN IN HANDLING AND STORING I - r

OTHER PRECAUTIONS ____. ~


Appendix B

Material Safety Data Sheet

Section 1. Identification

Product Name: Synonym(s): Formula: CAT No(s): Chem. No(s):

Section II. Product and Component Hazard Data

COMPONENT(S): Percent CAS Reg. No.

Section 111. Physical Data

Appearance and Odor: Melting Point: Vapor Pressure: Evaporation Rate: Volatile Fraction by Weight: Specific Gravity: Solubility in Water (by Weight):

~~ ~~

Section IV. Fire and Explosion Hazard Data

Flash Point: Extinguishing Media: Special Fire Fighting Procedures: Unusual Fire and Explosion Hazards:

Section V. Reactivity Data

Stability: Incompatibility: Hazardous Decomposition Products: Hazardous Polymerization:


Appendix B

Section VI. Toxicity and Health Hazard Data

A. THRESHOLD LIMIT VALUE: 6. EXPOSURE EFFECTS: C. FIRST AID:

Inhalation: Skin:

Ingestion:

- e:

Section VII. Ventilation and Personal Protection

A. VENTILATION: B. RESPIRATORY PROTECTION: C. SKIN AND EYE PROTECTION:

Section VIII. Special Storage and Handling Precautions

Section IX. Spill, Leak, and Disposal Procedures
