Safe Disposal in the COVID-19 Era

Safe Disposal in the COVID-19 Era

Challenges persist in managing waste for hospitals treating COVID-19 patients and aiming to limit the spread of the virus.

Institutions must now complete more steps on-site to safely collect, prepare and dispose of regulated medical and hazardous waste and sharps, while simultaneously protecting workers and the public, according to agency, state and waste hauler guidelines. These recommendations could change further as COVID-19 cases continue in hot spots throughout the United States and personal protective equipment (PPE) remains in short supply.

“‘How do I dispose of (fill in the blank) from a COVID-19 patient?’ is the single question I’ve been asked most on waste management during this pandemic,” said Cara Simaga, the director of government affairs at Stericycle, in a webinar she hosted with Selin Hoboy, the company’s vice president of government affairs and compliance.

Ms. Simaga assured listeners that “[generally, if you put waste] in the red bag before COVID-19, it still goes in the red bag today. If you put waste in the trash before COVID-19, it can still go in the trash today …. If you put something in a pharmaceutical waste container before COVID-19, it will still go there today.” Yet, she and Ms. Hoboy also characterized this pandemic period as a dynamic one, with process changes possibly ahead as scientists uncover new disease insights.

On one hand, Ms. Hoboy explained, the “enveloped virus is easily destroyed with normal disinfection procedures and typical waste treatment methods we use today. It is spread by close contact, so [social distancing is key].” On the other hand, SARS-CoV-2’s highly contagious nature and surface-sticking ability make waste management risky. The COVID-19 virus remains viable in aerosols for three hours, on plastic and steel for 48 to 72 hours, on cardboard for less than 24 hours, and on copper less than four hours (N Engl J Med 2020;382:1564-1567).

Stericycle imposed safety changes despite the CDC’s position that “medical waste (trash) coming from health care facilities treating COVID-19 patients is no different than waste coming from facilities without COVID-19 patients,” and despite a lack of federal guidance on managing regulated medical waste (sidebar).

Ms. Hoboy steered health care professionals, hospital safety directors and administrators toward state health department websites, the Healthcare Waste Institute of the National Association for Healthcare Waste Companies, and Stericycle’s own Knowledge Center (www.stericycle.com/ knowledge-center) as reliable, updated sources for the latest policies and recommendations.

Instead, “there’s a patchwork of regulations we must follow on a state-by-state basis,” said Ms. Hoboy, who urged those involved in waste management to “check regularly because [the regulations] might be changing.” Those tweaks, she said, might provide “regulatory relief, enforcement discretion, or fast-tracking medical waste generator registrations or waiving fees.”

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Best Practices for Waste During a Pandemic

The challenges of COVID-19-related waste management led Stericycle to reinforce best practices and add temporary changes to its Packaging Guidelines and Waste Acceptance Policies. The revisions include:

Hospitals must line shipping containers with red bags for regulated medical waste, and close and tie bags with a knot. This Department of Transportation regulation protects workers who open these containers to recycle cardboard or place tubs into the tub washer for reuse. Also, stay under the 50-pound limit per container for safe loading (exceptions are roll-up boxes or carts), and double-bag and absorb or solidify all liquid waste.

Stericyle drivers won’t accept improperly packaged waste for pickup or assist in packaging it. All containers must be properly labeled, closed and ready for removal, with no red bags visible. Nonconforming waste discovered at the facility will be returned to the hospital or redirected elsewhere for disposal.

Hospitals that don’t want to sign shipping documents can have the drivers print “Generator refused to sign COVID-19,” sign and date their section, and leave a copy for the hospital’s file.

Stericycle technicians don’t service sharps or comingled sharps and pharmaceutical containers in any hospital isolation rooms, regardless of airborne, droplet or contact precautions taken. Instead, Stericycle provides sufficient containers for hospital staff to put clean ones in patient rooms, removing the used ones and putting them in carts for pickup. “We believe it is prudent to limit the number of people that enter such rooms to limit disease spread and preserve scarce PPE,” said Cara Simaga, the director of government affairs at Stericycle.

Service technicians check with nursing stations before servicing a department to learn if there are any treatment areas they shouldn’t enter because of COVID-19.

Don’t place other waste types besides solid waste into red bags or sharps containers. Other types of waste could pose danger to workers. “Chemical waste, batteries, aerosol cans and gas cylinders could react dangerously in our processing equipment. We cannot accept [Resource Conservation and Recovery Act] hazardous waste and radioactive waste at our regulated medical waste facilities,” said Ms. Simaga, noting that other Stericycle divisions can handle many of these wastes.

Don’t place pharmaceutical waste into red bags. Continue to use blue and black pharmaceutical waste containers for that service.

Regulated medical waste and sharps should continue to be autoclaved. Incineration is needed only for pathology waste, trace chemotherapy waste and nonhazardous pharmaceutical waste. Once medical waste is treated, it can still be landfilled or sent to waste-to-energy sites.

Stericycle has established a business continuity plan to ensure ongoing services, and centrally communicates COVID-19 updates to health care facilities via its Knowledge Center (see main article).

—A.H.

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She shared Knowledge Center links from the CDC and the Occupational Safety and Health Administration on waste: bit.ly/3gtPUnv; bit.ly/2ZKHYZe; bit.ly/2B2nwsj; and bit.ly/2yDbAfM.

For further CDC/EPA guidance, visit bit.ly/3gxJEv2.

“Having managed Ebola in 2014, I’ve never seen anything of this magnitude. We certainly are in an unprecedented time,” Ms. Hoboy said. Actual direct waste from COVID-19 patients is “minimal,” with less blood and bodily fluids than during the Ebola outbreak, but there is “a lot more PPE and other solid waste generated” in hospitals as well as at pop-up testing sites, clinics, patient triage areas and quarantine sites in unconventional settings.