February 18, 2021

Keeping Staff Safe When Disposing of Trace Chemotherapy Drugs

Drugs used in chemotherapy, including antineoplastics and cytotoxics, are potent and toxic agents that can cause serious health problems for employees if the drugs and drug waste are improperly handled and disposed of. To protect staff, healthcare organizations should have clear waste disposal processes that mitigate exposure risk.

What Is Trace Chemotherapy Waste?

Trace chemotherapy waste includes PPE that is not saturated with hazardous drug waste, syringes and I.V. bags that have been fully administered, and containers that are RCRA empty, meaning that no more than 3% of the drug, by weight of the total capacity of the container, is remaining. Trace chemotherapy waste is transported and treated as regulated medical waste but is incinerated, not autoclaved.

What Is Bulk Chemotherapy Waste?

Bulk chemotherapy waste is chemotherapy waste that is not classified as RCRA empty or where there is more than a trace amount of chemotherapy drugs in or on the item being disposed, such as absorbent PPE that is saturated with chemotherapeutic agents and expired or partially used vials of chemotherapy drugs. Bulk chemotherapy waste goes into black containers used for pharmaceutical waste or into other appropriate hazardous waste containers. Bulk chemotherapy waste is picked up by vehicles permitted to handle hazardous wastes.

Use Proper Disposal Containers

  • Use yellow waste bags or yellow hard plastic containers (for sharps) specifically designed for trace amounts of chemotherapeutic drug waste. Trace chemotherapy waste is picked up by regulated medical waste vehicles. Only trace chemo goes into the yellow bags or sharps containers that will be picked up by regulated medical waste vehicles.
  • Place all trace chemotherapy drug delivery materials in the appropriate container, including empty chemotherapy drug containers (intravenous bags and associated tubing, bottles and vials), sharps, personal protective equipment (PPE) such as gloves and gowns, and other materials used in drug administration.
  • Waste containers used for trace chemotherapy waste should be single use (not reusable or recyclable) so as to avoid the possibility of exposing staff to dangerous trace amounts of chemicals that cannot be completely removed with cleaning reusable containers.
  • Containers should be designed for minimal handling. Drug residue can be transferred from contaminated surfaces to workers, and the active drug can be absorbed through unprotected skin.
  • Partner with your waste management company to create protocols for waste pick-up and disposal, including marking and labeling containers for incineration.

Dispose of Personal Protective Equipment Used In Trace Chemotherapy Waste

  • PPE, including gloves and gowns, which is contaminated with trace amounts of a chemotherapy drug, whether during drug administration or waste disposal, is disposed in trace chemotherapy yellow bags or single-use containers
  • Proper disposal prevents contamination of other areas of the hospital, including countertops, pens, IV pumps, doorknobs and elevator buttons

Provide Comprehensive Staff Training

Before interacting with chemotherapy waste, staff should fully understand:

  • Risks in handling chemotherapy drugs during drug administration and disposal
  • How to properly protect themselves, including what PPE to use and when
  • How to correctly dispose of all materials related to chemotherapeutic drug delivery
  • How to prepare containers for waste management pick up to avoid contaminating the environment

Understand Regulations and Guidelines on Chemotherapy Drug Waste

To ensure regulatory compliance and worker safety, familiarize yourself with the guidance and requirements of the following:

  • Occupational Safety and Health Administration (OSHA)’s Hazard Communication Standard (HCS) that covers proper hazard labeling and risk training
  • OSHA’s Bloodborne Pathogens Standard that covers how to mitigate needlestick injuries
  • Environmental Protection Agency (EPA)’s Resource Conservation and Recovery Act (RCRA) that includes regulations on disposal of hazardous waste pharmaceuticals
  • National Institute for Occupational Safety and Health (NIOSH) guidelines
  • United States Pharmacopeia (USP) General Chapter <800> that provides standards for the safe handling of hazardous drugs, which includes chemotherapy drugs
  • State and local regulated medical waste regulations

For an even deeper dive into the topic of trace chemotherapy drug disposal and keeping staff safe, check out Stericycle’s Hazardous Drug and Trace Chemotherapy Whitepaper.

Learn more about how Stericycle can help your staff with safe chemotherapy drug disposal and avoiding workplace contamination.

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