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Working with hazardous trash in home health care
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Ellen Carr MSN, RN Where does the medical waste involved in home health care go? In Texas, there are no laws requiring home healthcare workers to take special precautions when dealing with used needles and other hazardous waste; they’re free to throw it in the trash. But accrediting agencies require a well-defined medical waste disposal policy. And as the number and complexity of home care visits are expanding, home healthcare nurses and allied health professionals are increasingly looking at how medical waste disposal is being handled. "There is a growing acknowledgment that waste problems go beyond the sharps container," said Kelly Ochoa, RN, director of support services at Sharps Compliance Inc. in Houston. "Many agencies are getting concerned about a problem that has always been there–the car trunks of nurses, which can be ripe areas for medical waste co-mingling." It’s easy for infectious waste to look like average trash or for contamination to occur, she said. Focus of concern Discussion about medical waste generally focuses on needlestick threats. Estimates from the national Centers for Disease Control and Prevention (CDC) are that 1 million accidental needlesticks a year occur in inpatient and outpatient care settings, with 66 percent of all needlesticks going unreported. Clinicians can be exposed to a risk of infection from at least 23 bloodborne pathogens, including HIV and hepatitis B and C. Needles aren’t the only source of danger. Any medical waste product that comes in contact with bloodborne pathogens—such as wound dressings or bed linens—also carry risks. As the ways to deal with medical waste increase in importance, agencies and home care nurses will continue to find ways to deal with the challenge. "Home care agencies are heavily regulated," Ochoa said. "They do not want to take on any more regulations, so they will find ways to protect their patients and clinicians by taking on more responsibility for solutions." Regulation guidelines
The regulation of home care medical waste falls under many jurisdictions, including local, county, and state governments. Regulations typically have been enforced at the state or local level, with wide variations between the states. While the Joint Commission on Accreditation of Healthcare Organizations does not mandate any particular method of waste disposal—all that is required is that a regular process for disposal is in place. Occupational Safety and Health Administration (OSHA) standards and clinical professional associations—such as the Intravenous Nurses Society, Oncology Nursing Society, and American Nurses Association—publish guidelines and recommendations that inform practice. Processes in place Historically, clinicians working in home care have been exempt from most regulations governing the disposal of medical waste, according to Janet Emmerman, a national expert on medical waste issues. Those exemptions have been based on various criteria for waste processing and disposal established by home care clinicians. The criteria involve factors such as who is involved in transporting waste (RNs in some regions), the area in which the waste is generated (single-family homes), the nature of the waste (byproducts of home care—such as needles), and the volume of waste (the size or weight of the container must be small.) Home care workers have typically disposed of medical waste in one of three ways: centralized waste container disposal, home pick up by a licensed medical waste hauler, or individual contracting with haulers. Home care workers can also in some cases use the U.S. Postal Service, by sending containers designed for incineration through the mail. Discussions continue In the meantime, regulation discussions continue, with no final reading yet on how home care nurses will be affected. Earlier this month, the Department of Transportation enacted a new regulation that attempts to establish uniformity in the commercial transport and tracking of hazardous waste across state lines. Although medical waste—specifically associated with home care—is not the main focus, it is covered by the regulation. Experts suspect this new law will largely exempt home health care clinicians and sanction their current policies on medical waste. Ochoa said while regulation issues are ironed out, medical waste remains a hazard of the home care profession. "We as nurses really have no choice in our responsibility to deal with biohazardous waste … it’s a byproduct of what we do," Ochoa said. "If there was another way to deal with these wastes, we would welcome it." |
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