Medical Industry
Waste Prevention Round Table

MANAGING CHEMICALS
From Hospitals and Biomedical Labs III

Tuesday, November 13, 2001
8:30 AM - Noon
Center for Urban Horticulture, Seattle, WA

Chemotherapy waste
Chemo waste going through stericycle - do they incinerate or not?
One hospital representative believes their chemo waste is being incinerated at the Morton, WA facility.
Someone else heard that Stericycle is now sending to Utah and changing to reusable packaging tubs.
Does everything that is classified as Chemo waste need to be handled as haz waste? Need a list.
UW Hospital went through and developed protocol as to what designates and what doesn't
The time it takes to look at designation may not be worth the dollar savings of not having to handle the stuff as hazardous waste.
According to Dave, there is a great deal of variation among pharmacists regarding the handling of chemo waste.

Formalin / formaldehyde
The LC-50 for formaldehyde is based on old, bad russian "research".
CA EPA certifies chemical treatment technologies. Found two formaldehyde treatment (Vytex And Formalex?) actually end up as more toxic than formaldehyde.
The sewer limit is 0.1%. The standard was set with the protection of sewer workers in mind. Inhalation exposure is one of the main concerns.
Employees who handle formaldehyde need to be regularly tested.
Currently recommending Neutralex (prefered by many) and Form-x for formalin treatment.
Since Neutralex treats to below 100 ppm, the neutralex powder can be diluted up to 7:1 with water prior to treatment and still meet the sewer limit.
D-formalizer emits a stench like sulfur dioxide. Dave doesn't recommend using it unless under a fume hood.
Are there formalin substitutes?
One hospital has tried some of the alternatives but found that they have waste disposal issues. A lot of techs are used to formalin and don't want to use anything else.
Alchohol recyclers and formalin recyclers are available
There are also formalin filtration systems. They have been successful and are money savers.
Creative Waste Solutions - Rex Johnson - is a good place to get a formalin filter.
One hospital found filter was a cost drain because of the cost of the rebufferiung agent. Filtering formaldehyde was more expensive for them.
King County's discharge guidelines are more stringent than its neighbors. The limits are set for a number of reasons: treatment plant maintenance, capacities, processes, and ultimate discharge (to water or land); employee safety; and metals or toxins which the treatment plant doesn't remove much of. The limits are also influenced by local bodies of water.
Check with your local sanitary sewer district to see what local limits are. Limits vary considerably from location to location.
Labs have 100's to 1000's of different chemical compounds.
Wastewater employees should and are wearing a lot of protective equipment.
Industrial waste regulators are bewildered by medical facilities. They typically do not allow dillution as a solution.
Some labs will have limestone acid neutralization tanks.
These tanks are trouble if they're not maintained.
Medical facilities should check to see if they have them and then they should have them pumped out. Should check P-traps too for accumulated chemicals.
One hospital currently treating formalin with Neutralex but told by local wastewater people that they don't need to be doing that.
The main issue with aldehydes is the dangers to workers in the sewer lines.
What should be done with large formalin spills?
Formalex works fine. So does TransForm. One hospital red bags it but this is not necessary.
Formalin designates as a hazardous waste at 1%, and needs to be reported as such.
People are throwing away too much into the red bag waste. The problem is dealing with hospital workers - if it's not pure and still sterile they will put it into the red bag. Red-bag contamination is also due to the fact that the location of the red bag is often more convenient than the proper container.

Disinfectants
EPA's and Ecology's hazardous waste group are not currently checking on or enforcing the disposal of empty disinfectant containers as pesticide containers requiring triple rinsing. There are 4 inspectors in the region and they don't have time to spend on this.

X-ray processing chemicals
Dave has seen lots of x-ray processing units, many of which have inadequate silver recovery systems.
Are there insurance liability concerns about digital imaging?
Big upfront cost for imaging equipment but longer term costs are very low - saves on time (faster exposures), getting consults (can send electonicaly vs. via carrier).
Ron Claus had a booklet on silver recovery. Contact him for more info.

Mercury wastes
Some Oregon doctors are saying they have to have mercury thermometers. A lot of medical facilities have gotten rid of Hg thermometers.
King County Transit switched to low Hg flourescent tubes in busses but found that the didn't last as long.
One facility virtually eliminated Hg in pathology - an Alaska partner hospital sent samples in a Hg presertvative- don't know what to do with the waste now since they aren't really set up anymore to handle Hg at all.

Stains
Dave and Ron will work on determing if uranyl nitrate or uranyl acetate can go down the drain. Will provide info to Dynacare on this.
DAB (diaminobenzidine) needs to always go to haz waste though, depending on concentration after use, it might be able to go to serwer. Dave will respond to Dynacare about this too.
Dave came up with specific guidleines on Ethinium Bromide <0.1% goes to solid waste >0.1% in gel form dispose as haz waste <10 micrograms/ml treat and put down the drain
One biotech representative said a company wants to take their haz waste as a materiall for testing their new system.
WAC has a "treatability study" protocol which could be followed.

Other issues
When decontaminating someone after a chemical exposure, should the rinse water (with chemical contamination) be captured?
This goes on a case by case basis.
Dave said he will go back to industrial waste and talk to them about emergency discharges.

When preparing to determine regulatory oversight of an issue, remember…

• Federal regulations are the basic standard
• State regulations are often more stringent than the federal regulations
• County can sometimes create stuff even more stringent than the state

Dave gave an overview and update on where the pharmaceutical process was and wasn't at.
Sandy talked about antibiotics in our drinking water.

Meeting adjourned

What is the Medical Industry Waste Prevention Roundtable? The Roundtable was established in early 1999 to bring together medical industry professionals who are interested in exchanging ideas on, and developing new ways of, preventing and reducing waste. This year the group is hosting five seminars to develop cost-effective, environmentally sound solutions for managing major medical wastes such as products and packaging.

For more information on the seminars or MIRT in general, please visit the web site at www.nwmedicalwaste.org or contact Kinley Deller at (206) 296-4434 or kinley.deller@metrokc.gov.