5 April 2021
With three approved vaccines available for distribution, the COVID-19 immunization effort is in full swing in the U.S. A key part of this massive public health initiative involves preparing for and handling the increase in vaccine-related waste volume. The following sections answer frequently asked questions related to compliant vaccine waste management that safeguards staff, patients, and the environment.
Overall, COVID-19 vaccine waste disposal should follow the same processes used for other types of vaccine waste disposal, such as that for the regular flu shot. Since COVID-19 vaccines currently do not contain components that would require leftover doses to be treated as hazardous waste, the standard protocols apply. However, when considering the materials used to administer vaccines, there are specific requirements and best practices to be aware of. Here are a few recommendations broken down by supply type:
Used syringes should always be thrown away in sharps containers and disposed of as regulated medical waste (RMW). These containers can either be reusable or disposable, as long as they have U.S. Food and Drug Administration (FDA) market clearance. A benefit of using reusable containers is that they reduce the amount of plastic going to landfills. That said, for organizations that don’t normally generate a large volume of sharps—such as non-hospital facilities—disposable container options may be more cost effective.
Ideally, empty, full, or partially used vaccine vials that are no longer needed should be thrown away in sharps containers, which are disposed of as RMW. Not only does this prevent injury if the glass vials break, but it also mitigates the risk of diversion for illicit intent. However, some states may require organizations to manage vials as non-hazardous pharmaceutical waste. Therefore, it is important to check your state requirements to make sure you are compliant.
It is wise to check with the vaccine’s manufacturer about the correct method for vial packaging disposal, such as trays and boxes. The manufacturer may indicate that the material can be disposed of as RMW, or they may want certain components of the packaging to be returned. Even though packaging is not typically considered RMW, there are concerns that some of it could be intercepted and used to market counterfeit vaccines. Treating the packaging as RMW helps reduce the chances of improper use.
Some vaccine manufacturers are using dry ice in vaccine packaging to help maintain the appropriate vaccine temperature. Healthcare organizations should follow CDC guidance for disposal of dry ice. While effective at temperature control, dry ice can introduce risk when it comes to disposal. This solid form of carbon dioxide (CO2) doesn’t melt or turn into liquid. It moves directly from a solid to a gas through a process called sublimation, releasing CO2 directly into the air. This is only a problem when the dry ice is stored in an enclosed area without proper ventilation. The excess CO2 can displace oxygen, causing asphyxiation, and there is no odor or warning to alert people of the danger. For that reason, you should only allow dry ice to sublimate in an outdoor or well-ventilated area. Never put it in a waste container or enclosed waste storage area. To ensure safety, manufacturers may supply dry ice disposal instructions along with the vaccine. Reviewing these carefully can help avoid a dangerous situation. Always follow CDC and/or manufacturer guidance if available.
Personal protective equipment (PPE) used during vaccine administration
All PPE used during the process of inoculating patients, including masks, alcohol wipes, bandage wrappers, cotton balls, gowns, and gloves—unless contaminated—can be thrown away in the regular trash, unless your state regulations consider it RMW.
The best way to prepare is to develop a vaccination plan that describes where vaccine administration will occur, the expected number of patients and vaccinations, how many sharps containers will be required, and where the organization will obtain enough sharps containers to accommodate the anticipated waste. Having the right number of containers on hand is critical so you are not put in the position of borrowing containers from other areas of the hospital, which could cause shortages and put staff and patients at risk.
For vaccination administration within your facility, consider expanding the inventory of sharps containers to accommodate the increased waste. For off-site administration, think about purchasing additional sharps containers to manage waste. To simplify waste collection, you may want to limit vaccination locations. Note that not every site will administer the same number of vaccines, and you may need to switch between two-, four-, and eight-gallon containers depending on the volume. Keep in mind that approximately 500 3cc syringes fit into a four-gallon sharps container.
Like hospitals, having a plan for the temporary influx in waste is key to effectively managing vaccine distribution. As part of this plan, you should consider which service is the right choice, given the anticipated volume. Certain options, like disposable and reusable sharps container programs, include scheduled pickups where trained drivers retrieve the containers and take them to a permitted waste management facility for treatment and processing. Sharps mailback solutions are meant for smaller volumes and require the organization to package the waste in a supplied shipping box and send the sealed box back using the United States Postal Service. Whatever disposal solution you choose, it is important to order sufficient supplies to accommodate the projected demand.
The FDA considers sharps containers to be medical devices and must therefore clear them for use. In addition, the Occupational Safety and Health Administration (OSHA) has specific marking and labeling requirements for these containers. Organizations should not use random containers, such as glass jars or re-purposed plastic receptacles because they will not be cleared for use by the FDA, and they will not have the proper labeling required by OSHA. To avoid this situation, it is critical that you plan for and stock up on the necessary number of sharps containers.
Stericycle offers a range of solutions designed to handle RMW safely and compliantly, including a variety of reusable and disposable sharps containers. We also remain in close contact with the Centers for Disease Control and Prevention (CDC) about vaccination planning, administration, and education resources and update our COVID-19 information hub with the latest information.
Learn more about what Stericycle is doing to support COVID-19 vaccination efforts, or how our solutions can assist with your organizations' vaccine waste disposal.
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