The 5 Most Common Medical Waste Violations in Healthcare Facilities

With so many steps in the management of medical waste, it can be easy for healthcare facilities to overlook a few details and fall on the wrong side of federal and state regulations. Many rules around accumulation and transportation are state specific so it is important to understand where common violations occur so that you can avoid the same costly and potentially dangerous mistakes

1. Inadequate Employee Training

Your plans and processes for handling, storing and disposing of medical waste are only as effective as your employees executing them.

In 1991, the Occupational Safety and Health Administration (OSHA) introduced the Occupational Exposure to Blood Borne Pathogens (often referred to as BPP) Standard. The Standard defines how to correctly identify, segregate and manage your regulated biomedical waste. As an employer it is your responsibility to ensure all employees with occupational exposure are adequately trained. In doing so you can largely avoid the other four most common violations throughout this blog, as well avoiding any employer violations too. In addition to ensuring staff are trained, you must also keep appropriate training documentation. Violations for Large Quantity Generators (LQGs) often include missing or incomplete documented records.

Staff must complete training annually (in addition to initial training) and retraining when new procedures come into effect. Violations often occur when healthcare providers fail to meet this regularity.

In addition to BPP standards, staff should also be trained in:

• Hazard Communication Standard (HCS)
• Health Insurance Portability and Accountability Act (HIPAA)

Lack of adequate training can be costly and dangerous. There is a real life-threatening risk to your employees, patients and other waste handlers from improper medical waste disposal practices and inadequate OSHA training. When the Department of Transportation (DOT) performs audits they will question your employees. Employees will be expected to know about the materials they handle and how to correctly categorize and package them. Failure to correctly answer these questions will lead to non-compliance and your healthcare facility receiving a citation.

Employees handling medical waste can be trained by the employer provided the trainer has thorough knowledge and expertise in the area of occupational hazards of blood borne pathogens. However, many healthcare providers choose to use medical waste disposal services to provide their staff training as they have ready-made and current training programs. Many facilities think that having access to training materials makes them compliant, but then fail to follow through and fully, and adequately, train their staff.

Many of the most common violations can be avoided by adequately training your employees and by keeping their training records up to date. MedPro Disposal offers a range of online safety compliance programs designed to meet Hazcom, BBP and HIPAA requirements. Training takes less than an hour and includes a certificate of completion. Make sure you are reducing your exposure and liability by adequately training your staff.

 2. Container Management & Labeling

You probably won’t be surprised to see basic container management on this list as it covers such a variety of violations. The most common violations for healthcare facilities include:

• Incorrect container requirements – it may seem obvious, but some of the most common violations occur by using the wrong type of container. The example most commonly used is the need to keep sharps (anything used for injecting, cutting, etc.) in rigid, puncture proof containers. In the past, workers might have used improvised containers like empty milk jugs, but these days you must use DOT certified containers that are leak-proof and tamper-proof in addition to their protection qualities. They are also reusable provided they are not damaged.

• Segregation by compatibility – putting waste into containers that are not compatible. For example putting used needles into a red biohazard liner would be a clear violation as these liners are specifically for non-sharp infectious waste and blood products. You must also segregate your regular trash from medical waste.

• Incorrect labeling – labeling requirements can be very specific so create a lot of potential for committing violations. These range from incorrect use of colored bags to failing to include a date of accumulation label (day, month and year, as well as the time of first addition). The sheer number of accumulation containers and employees handling them in most healthcare facilities means that labeling violations carry a high probability. The only way to stay on top of this issue is through constant vigilance and reinforcing the need for proper labeling.

• Failing to keep containers closed – containers that are left open, or half open, amount to a clear biomedical waste violation. The laws on this point are very clear – drums and other containers must be kept closed and latched at all times except when adding or removing waste. Containers that are damaged, or in poor condition, can also lead to them becoming a source of transmitting infection and therefore also violate this basic requirement of container management standards.

• Failing to inspect your medical waste containers – Inspections of medical waste containers must be made every week. The inspection must be fully documented with the date and the inspector’s initials. Many healthcare facilities already designate an employee to routinely inspect fire extinguishers and other safety devices. It might be easiest to incorporate medical waste container inspections into the routine of such an individual.

• Failing to handle containers correctly – Any handling that could cause a rupture or leak is a violation of basic container management.

Basic container management is an essential requirement for all healthcare facilities and the employees working in them, from medical professionals to cleaning operatives. Proper employee training and well-established policies and processes can go a long way in avoiding these common violations.

 3. Lack of Emergency Contingency Plans

Are you ready for the unexpected? Healthcare facilities have emergency plans for a variety of situations and similarly all LQGs are required to have a contingency plan in events such as accidental spills or loss of containment of biomedical materials.

Your emergency plan must be sent to local authorities and a copy must be posted by an on-site telephone. Your contingency plan must be updated every year in addition to following any significant changes at your healthcare facility.

Common violations in this area include:

• Missing required details of the contingency plan – for example having sufficient red biohazard bags on-site to enclose 150% of the maximum load accumulated.

• Inadequate plan distribution – for example not disseminating the contingency plan to all waste handling employees.

• Inconsistency with current operations – for example failing to update your contingency plan following a significant increase in the amount of medical waste being generated.

• Out of date plans – for example failing to complete your annual review of the contingency plan.

Medical waste disposal services like MedPro Disposal can take the stress out of contingency planning and help you develop your preparedness with our online plan builder. The plan covers the following areas:

• Hazard Communications

• Exposure Control

• Fire Prevention

• Emergency Preparedness

4. Improper Waste Segregation

Are you properly segmenting your medical waste from your non-contaminated waste? All medical waste generators are required to correctly identify their waste. This should be done through knowledge of the waste stream, or by testing it. Determining hazardous biomedical waste should be second nature to you and your employees, but violations still occur when generators fail to properly identify all of the potentially infectious waste streams at their facilities. Some wastes are commonly overlooked, such as cotton and other blood stained materials, which can get thrown into the ordinary trash.

Other items that are defined as being hazardous in federal, state or local regulations must never be placed in a medical waste container. This includes, but is not limited to:

• Formaldehyde / Formalin or Formaldehyde Products

• Solvents, Paints and Paint Thinner

• Drums or Other Containers with Universal Hazardous Warning Symbol

• Batteries of Any Kind

Placing these hazardous materials in with your medical waste can result in fines and even jail time so correct determinations are extremely important.

In addition to correct identification of biomedical waste, other violations can include delaying the formal waste determination process – you may know a material is medical waste, but failing to document the determination and label the material as such within the correct time frame can lead to a citation.

Like many of the other common violations, determination of untreated medical waste can come down to employee training. Staff must understand whether the materials they are handling are potentially infectious and how to classify them. Often employees assume that the package in which a product was shipped is appropriate for storing waste. However, once a product is contaminated and has been labelled “waste” the requirements for storing and transporting the product change.

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 5. Improper Transportation Practices

Violations of medical waste disposal are not limited to on-site the healthcare facility, but occur along the transportation process too. The regulations for transporting medical waste are broad, and can vary by state – this leaves you open to a variety of violations, whether you transport your own medical waste off-site or not. If you are transporting large amounts of waste (anything of 50 pounds or more) you are always required to have a permit from their local or state regulator.

There are a number of transportation practices that you must abide by and violations can occur when any of the requirements are not met. These include:

• Incorrectly packaged waste in non-DOT approved containers.

• Incorrect labelling of transportation containers, for example not including the universal hazardous symbol.

• Failure to correctly initiate and maintain a record of each waste shipment collection and deposition.

• Failure to meet transportation vehicle requirements, for example using vehicles that cannot maintain required storing temperatures.

• Failure to correctly store medical waste in a sanitary condition during the transportation process.

• Failure to correctly clean and disinfect the transportation units

• Failure to pay fees for transporting untreated medical waste (these vary from state to state)

Obtaining a permit to transport your own untreated medical waste and avoid the above violations is very costly and requires hours of training for your employees. This is why most LQGs use medical waste disposal services to fulfil these needs.

To avoid transportation violations, you can use medical waste disposal companies like MedPro Disposal who have compliant vehicles available and trained operatives who bring expert knowledge and experience to correctly transport and dispose of your medical waste. The medical waste disposal service will absorb the majority of the responsibility of handling and transporting the waste and reduce your risk of non-compliance.

Conclusion

Violations against government regulations regarding your medical waste disposal should not be taken lightly. Receiving an investigation notice, or worse, a penalty notice, can be a scary experience. Violation fines will put an unnecessary financial burden on your healthcare facility, but more importantly will highlight that you are not ensuring the safety of your patients and employees.

There is very little consistency from one state to another in terms of regulating medical waste disposal and it’s easy to feel overwhelmed in staying compliant. MedPro Disposal can take on this responsibility for you, ensuring that your healthcare facility is in total compliance with all unique, state regulations.

If you are confused or want to check that you’re not in any violation, contact MedPro Disposal today for information and reassurance. Allow us to take the stress and hassle out of your medical waste disposal needs.

References

1. https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051
2. http://www.hercenter.org/rmw/osha-bps.cfm#train
3. http://www.michigan.gov/deq/0,4561,7-135-3312_4118_4240-18543–,00.html
4. http://www3.epa.gov/epawaste/nonhaz/industrial/medical/mwpdfs/modguidl/3.pdf
5. http://www.tceq.state.tx.us/permitting/waste_permits/msw_permits/mw_disposal.html

*The materials available at this website are for informational purposes only and not for the purpose of providing any State or Federal Guidelines or any legal advice.