28 April 2021
Long-term care organizations and nursing homes produce many kinds of waste during the care and treatment of residents. In these settings, proper waste management is essential to keep people safe, protect the environment, and ensure regulatory compliance. The following sections provide information and guidance for long-term care facilities and nursing homes on how to correctly segregate waste, including that generated during COVID-19 treatment.
Most of the waste in these facilities is non-regulated waste, meaning it’s the same as the waste produced by other businesses, such as hotels. Approximately 60% of this waste is recyclable.
The majority of the remaining waste falls in the categories of regulated medical waste (RMW) and hazardous waste, which cover a range of items, including sharps, biohazardous materials, and pharmaceuticals. As part of the disposal process, staff must segregate waste into different containers, so it can be handled and managed appropriately according to its risks.
Any contaminated item that could puncture the skin should be thrown away in an FDA-cleared, labeled sharps container. Applicable items may include syringes, needles, scalpels, glass vials, and so on. Designed to prevent punctures, leaks, and overfilling, these containers can reduce the chances of needlesticks, which can cause exposure to bloodborne pathogens.
Organizations may opt to use reusable containers as part of sharps disposal efforts. These containers are made of hard plastic that can be reprocessed and reused, which ultimately reduces the number of receptacles ending up in landfills.
For organizations that do not generate a large volume of sharps waste, a mail-back program may be appropriate. This involves disposable sharps containers that are shipped to the organization with easy-to-follow instructions and a prepaid return-shipping box.
While there is no universally accepted definition of medical waste, federal and state agencies differentiate those wastes that have potential for causing harm and infection and have regulations around the collection, transportation, treatment, and disposal of them. RMW that is not a sharp belongs in an RMW container lined with a red medical waste bag. When the bag is full, staff should hand tie and knot the bag to secure it. Overfilling red bags can make them too heavy, which can cause them to rip or break. Wet or leaking containers will not be accepted by a waste hauler.
Gowns, gloves, face masks, and other personal protective equipment (PPE) used during resident care should be treated as either regular trash or RMW, depending on whether the items are contaminated with blood or other bodily fluids, which could contain pathogens dangerous to humans and the environment. Organizations should clearly define parameters for PPE waste segregation to ensure proper disposal of used PPE.
Pharmaceutical waste is any leftover, unused or expired medication that is no longer needed. It can be classified as either hazardous or non-hazardous depending on its chemical properties and risks. Inconsistent drug disposal can result in dangerous chemicals leaching into the surrounding environments and contaminating groundwater, drinking water, plant life, and more.
While non-hazardous pharmaceuticals should be segregated from other RMW into a container specifically designated for non-hazardous pharmaceutical waste and destined for incineration, hazardous pharmaceuticals have different waste requirements due to the increased risk to humans and the environment.
A controlled substance is any drug that is regulated by the Drug Enforcement Administration (DEA). The DEA organizes controlled substances into groups – called schedules – based on the drug’s risk of harm or abuse. Because of the high risk to people and communities, the DEA has specific disposal requirements for controlled substances to prevent diversion—when someone steals drugs to use for non-therapeutic purposes. The long-term care setting is prone to drug diversion due to the frequent use of opioids, such as oxycodone, in treating residents’ pain. Other risk factors include persistent staffing shortages, high turnover rates, fewer administrative controls, and fewer resources for oversite.
Because of the risks associated with these drugs, long-term care organizations and nursing homes should have a robust drug diversion prevention program in place, which may entail comprehensive staff training among other tactics.
According to the Centers for Disease Control and Prevention (CDC), waste generated from the care of COVID-19 patients is no different than waste generated from the care of non-COVID-19 patients, and there is no evidence that additional disinfection is required. As such, organizations should treat the waste the same way they always do. Current RMW procedures are already sufficient to protect human health and the environment, even when COVID-19 is involved.
Note that RMW is mostly governed at the state level, so it is important for an organization to check its state’s rules and regulations to make sure they are aligned with their state requirements regarding Coronavirus (COVID-19) waste management. Some states have suggested that PPE used while treating COVID-19 patients be managed as RMW.
Learn more about COVID-19 waste disposal, hospital waste procedures, vaccination waste disposal, and more on our COVID-19 Knowledge Center Hub.
Long-term care organizations and nursing homes have been disproportionately affected by COVID-19, and many facilities have been treating numerous severely sick people at once. With the unknowns of the disease coupled with the fear of spreading the virus, staff in some facilities have opted to air on the side of caution and overclassify waste, treating items normally considered regular trash as RMW. This can dramatically increase the costs of waste management unnecessarily.
Organizations should treat waste as they normally would, which means regular trash should still be considered regular trash. Organizations should also provide clear guidance in this area, so staff fully understand how to keep themselves and their residents safe. Providing additional training, sharing the CDC’s COVID-19 waste recommendations, and answering frequently asked questions during staff meetings are all good ways to educate employees on this topic.
Staff play a key role in ensuring waste ends up in the right container every time. If employees are not careful about how waste is thrown away, they can inadvertently cause serious harm to themselves, their residents, and the environment. Conversely, they can increase the cost of waste management as well.
Because of these factors, it is essential for organizations to provide recurring training and education on regulated medical waste segregation. Not only does this enable a safer and healthier working environment, but several states and regulatory bodies have also defined waste disposal training requirements that organizations must meet to remain in compliance.
Staff training and education should be varied to keep it fresh and compelling and include real-world applications so employees can easily apply what they learn to their day-to-day work. Online education tools can be especially valuable. Modules are continuously updated, offering the latest information, and allowing staff to complete training at their convenience. Participation is documented and can be used to demonstrate compliance.
Regulated medical waste training should be one element in a comprehensive staff education program. Other topics to address include OSHA training and HIPAA training. When a long-term care organization or nursing home provides a multifaceted training program, it can go a long way toward ensuring a safe and secure environment for residents and staff.
From COVID-19 waste and sharps disposal to regulated medical waste, Stericycle can partner with your long-term care facility or nursing home to ensure sound, compliant, and reliable waste management. Visit our medical waste solutions for more information.
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