West Tennessee Healthcare Part 3 Hazardous Pharmaceutical Waste Program: RCRA Waste Why are we concerned about hazardous pharmaceutical waste? EPA has determined that certain pharmaceutical waste is hazardous to the environment when disposed of improperly. The Joint Commission requires our compliance with EPA regulations. Non-compliance can result in fines of >$30,000 per instance per day. What is this about? The proper identification and safe disposal of certain pharmaceutical hazardous waste What does this mean to the organization? Properly identifying Segregating Storing Manifesting (documenting details) and Transporting and disposing waste (incinerating at a federally permitted facility) What does this mean for nursing and patient care areas? Properly identifying Segregating What goes in these black RCRA waste bins? 3 categories of hazardous pharmaceuticals: P-Listed, U-Listed, and D-Listed meds
What goes in these BLACK waste bins? P-Listed items: 1. All unused Nicotine products and empty wrappers 2. Warfarin (Coumadin ) and empty packages 3. Physostigmine (Antilirium ) *drug, package, med cup, IV tubing, IV bag (whether empty or not) *Arsenic Trioxide (Trisenox ) Requires special disposal separate from other RCRA waste U-Listed and D-Listed Waste: Medication containers if more than 3% of the drug remains (essentially any pill or ointment left or enough liquid to swish in the container). When these drug containers are empty, they can go in the regular trash. The following is the list of RCRA pharmaceutical hazardous waste products on our formulary. This list is laminated and posted in appropriate areas. Labels with this information will be placed on RCRA black waste bins. Hazardous Pharmaceutical Waste Disposal RCRA Requirements P-Listed Drugs: ALL Containers (wrapper, cup foil, IV bag, IV tubing, syringe) and ANY drug waste should ALWAYS be discarded as hazardous waste: Nicotine products (all) Physostigmine (Antilirium) Warfarin (Coumadin) U and D-Listed Drugs: Partially full containers (you can still swish liquid) and any drug waste should be disposed of as hazardous waste: [Empty containers (you CANNOT swish liquid) should be disposed of as infectious waste or regular trash as appropriate] Amyl Nitrite Meningococcal vaccine (Menomune) Androgel Mitomycin (Mitomycin C) Benzoin Tincture Neomycin/Polymixin B/Gramicidin ophth soln (Neosporin Ophth solution) Betamethasone Valerate Lotion Paclitaxel (Taxol) Cortisporin ophthalmic suspension Phisohex soap Cyclophosphamide (Cytoxan) tablets and inj Reserpine Cyclosporine (Sandimmune) injection Selenium injection
Daunorubicin HCl (Daunomycin) Selenium sulfide shampoo (Selsun Blue, Head and Shoulders) Dehydrated alcohol Silver Nitrate Solution and sticks Dermoplast spray Silver Sulfadiazine Cream (Thermazine, Silvadene) Ethyl Chloride Spray Streptozocin (Zanosar) Etoposide (Vepesid) Tetanus Toxoid Fluocinolone Acetonide Oil (Derma Smoothe/FS) Teriparatide (Forteo) Flurbiprofen Sodium Trichloracetic Acid topical (Tri-Chlor) Teriparatide (Forteo) Viroptic Ophthalmic solution Hyaluronidase (Amphadase) TPN's Insulins (ALL) Including insulin drips Lindane Shampoo and lotion (Kwell) Lopinavir/Ritonavir (Kaletra) Mastisol Melphalan (Alkeran) Arsenic Trioxide (Trisenox) : RETURN ALL CONTAINERS ( IV bag and tubing) to the Oncology Pharmacy for disposal WTH has contracted with a company to safely dispose of hazardous pharmaceutical waste. Cost is calculated by weight. It s very important than only RCRA pharmaceutical waste is put into these black containers. Educate co-workers in other departments not to place inappropriate trash in black bins. All expired insulin vials that contain enough medication to swish go in the black RCRA waste containers for disposal. Empty syringes and needles still go in sharps containers. If a syringe contains a significant amount of insulin, empty into a black RCRA container and discard needle and syringe in the sharps container. The alcohol in alcohol wipes evaporates quickly. Use the wipe on the patient until it dries. If significant moisture remains, it should be disposed in the black RCRA waste containers. *skin prep solutions and cleaning agents are not classified as hazardous pharmaceutical waste
As a helpful reminder to staff, one of these messages will appear in Pyxis when dispensing a RCRA hazardous pharmaceutical: Black Bin Disposal Required or Black Bin Disposal if Not Empty Nurses will be required to answer yes to proceed. Pharmacy will also place black dots the patient slips of RCRA waste drugs sent from pharmacy. Global Harmonization System (GHS) Safety Data Sheets (SDS) OSHA has modified the Hazard Communication Standard to adopt the Global Harmonization System (GHS) to improve safety and health of workers through more effective communications on chemical hazards. The GHS provides a standardized approach, including detailed criteria for determining what hazardous effects a chemical poses, as well as standardized label elements assigned by hazard class and category. This will enhance both employer and employee understanding of the hazards, which will in turn help to ensure appropriate handling and safe use of workplace chemicals. What you now know as Material Safety Data Sheets (MSDS) will be changed to Safety Data Sheets (SDS). The SDS will contain basically the same information as the MSDS but it will be in an order that is standardized. The standardized format of the safety data sheets will enable people to access the information more efficiently and effectively. Chemical manufacturers, distributors, importers must begin using the new labels and SDS by December 15, 2015. We must complete the training now because it is important to ensure that when employees begin to see the new labels and SDS in their workplaces, they will be familiar with them, understand how to use them, and be able to access the information effectively. The changes that you will see involve: Labels: Chemical manufacturers and importers will be required to provide a standardized label that includes; Identity: Identifies the chemical name. Pictogram: A black symbol on a white background inside a red diamond. This
is meant to give you specific information about the hazards of a chemical. Example: Health Hazard Signal Words: One word used on the label to indicate the severity of a hazard and alert the reader to potential hazards. The two signal words used are: DANGER and WARNING. Danger indicates a more severe hazard than warning. Hazard Statement: A statement assigned to a chemical that describes the nature of the hazards associated with that chemical. Precautionary Statement: A phrase that explains the measures to be taken to minimize or prevent adverse effects of exposure to a hazardous chemical, improper storage, or handling of a hazardous chemical. Manufacturer or Distributor: Contact information of the chemical manufacturer or distributor. Example GHS Label Flammanite (fictional) Identity Hazardous Components: Ethyl Alcohol (64-17-6) Methanol (67-56-1) DANGER Signal Word Pictograms Highly flammable liquid and vapor. Causes severe skin burns and eye damage. May be harmful if inhaled. May cause respiratory irritation and drowsiness or dizziness. May cause cancer. May damage fertility or the unborn child. Hazard Statements Prevention; Avoid breathing dust, fume, gas, mist vapors and or spray. Wear protective gloves, clothing, and eye/face protection. Wash thoroughly after handling. Do not handle until all safety precautions have been read and understood. Ground and/or bond containers and receiving equipment. Keep away from heat, sparks, open flames and/or hot surfaces. Use explosion proof electrical equipment. Use only non-sparking tools. Avoid releases to the environment. Precautionary Statements Response; IF IN EYES: Rinse cautiously with water for several minutes. Remove contact lenses, if present and easy to do. Continue rinsing. If eye irritation persists get medical advice. IF ON SKIN; take off immediately all contaminated clothing. Rinse skin with water/shower. If skin irritation occurs get medical advice. IF INHALED; Remove victim to fresh air and keep at rest in a position comfortable for breathing. In case of fire: use appropriate media for extinguishment. Storage/disposal; Dispose of contents and container in accordance with local, regional, national and/or
international regulations. Store in a well ventilated place. Keep container tightly closed. Manufacturer/Distributor The 9 GHS Pictograms and Hazards Health Hazard Flame Exclamation Mark Carcinogen Mutagenicity Reproductive Toxicity Respiratory Sensitizer Target Organ Toxicity Aspiration Toxicity Flammables Pyrophorics Self-Heating Emits Flammable Gas Self- Reactives Organic Peroxides Irritant (skin and eye) Skin Sensitizer Acute Toxicity (harmful) Narcotic Effects Respiratory Tract Irritant Hazardous to Ozone Layer (Non Mandatory) Gas Cylinder Corrosion Exploding Bomb Gases under Pressure Skin Corrosion/ burns Eye Damage Corrosive to Metals Explosives Self-Reactives Organic Peroxides Flame over Circle Environment (Non Mandatory) Skull and Crossbones Oxidizers Aquatic Toxicity Acute Toxicity (fatal or toxic) Safety Data Sheets (SDS): Will replace the current Material Safety Data Sheets. (MSDS) The SDS will have a specified 16-section format that will provide the following information on a hazardous chemical. Section 1. Identification Section 2. Hazard(s) identification Section 3. Composition/information on ingredients Section 4. First-Aid measures Section 5. Fire-fighting measures Section 6. Accidental release measures Section 7. Handling and storage Section 8. Exposure controls/personal protection Section 9. Physical and chemical properties Section 10. Stability and reactivity Section 11. Toxicological information Section 12. Ecological information Section 13. Disposal considerations Section 14. Transport information Section 15. Regulatory information Section 16. Other information, including date of preparation or last revision
Understanding the numbers; Under section number 2, Hazard Identification, the SDS will list the category of the hazard. Under the GHS system the lower the number the higher the hazard Signal Word Cat 1 severe hazard Danger Cat 2 serious hazard Danger Cat 3 moderate hazard Danger Cat 4 slight hazard Warning Cat 5 minimal hazard Warning Under the NFPA System we currently use the lower the number the lower the hazard 4 = severe 3 = serious 2 = Moderate 1 = Slight 0 = Minimal