Lecture 13-Managing Pharmaceutical Waste
what are U-listed chemicals
-21 drugs on the U-list -listed primarily for their toxicity. Similar to a P-listed waste, when a drug waste containing one of tehse chemicals is discarded, it must be managed as hazardous wast if two conditions are satisfied: --the discarded drug wast contains a sole active ingredient that appears on the U list --it has not been used for its intended purposes
what are some examples of P-listed waste?
-Arsenic trioxide -epinephrine -nicotine -nitroglycerin (excluded federally and in some states) -phentermine (CIV) -physostigmine -physostigmine Salicylate -Warfarin >0.3%
How is Pharmaceutical Wast Generated at the Healthcare Facility
-IV preparation -General Compounding -Spills/breakage -paritally used vials -partially used syringes/IVs (if contaminated, biohazardous) -discontinued, unused preparations -unused repacks (unit dose) -patient's personal medications -outdated pharmaceuticals
what kind of set and tubing should be used with chemo drugs
-Non-PVC sets -polyvinyl chloride can form dioxin when incinerated and sometimes these dioxins can be carcinogent
when is a U list container considered empty
-all contents removed that can be removed through normal means and no moer than 3% by weight remains
Characteristic of corrosivity
-an aqueous solution have a pH less than or equal to 2 or greater tahn or equal to 12.5 -examples: primarily compounding chemicals (glacial acetic acid, sodium hydroxide -hazardous waste numner: D002
Characteristic of ignitability
-aqueous solution containing 24% alcohol or more by volume and flash point <140 degrees F -hazardous waste number: D001 -topical preparation -injections
examples of U-listed pharmaceutical waste
-chloral hydrate -chlorambucil (chemo) -cyclophosphamide (chemo) -daunomycin (chemo) -diethylstilbestrol (chemo) -melphalan (chemo) -mitomycin (chemo) -streptozotocin (chemo) -lindane -sccharin -selenium sulfide -uracil mustard (chemo) -warfarin <0.3%
What are P-listed chemicals
-commercial chemical products that are categorized as acutely hazardous under RCRA
how much drug is usually in a patch?
-most transdermal patches contain 20 times the amount of drug that will be absorbed during the time of application
Drugs meeting NIOSH hazardous drug criteria
-myagenicity -carcinogenity -teratogenicity or other developmental toxicity -reproductive toxicity -organ toxicity at low doses -genotoxicity -structure and toxicity of new drugs that mimic existing drugs determined hazardous by previous criteria
municipal incineration
-permitetd to burn municipal "garbage" -usually not permitted to handle infectious waste -may be permitted to handle non-hazardous pharmaceuticals, with certain volume restrictions
Medical waste incineration
-permitted by USEPA and the state to accept pathology waste, red bag and red sharps waste, trace chemo waste -may be permitted to accept non-hazardous pharmaceutical waste
hazardous waste incineration
-permitted by USEPA, known as treatment, storage, and disposal facility (TSDF) -high temperature, molecular bonds broken -authorized to accept the "worst of the worst" hazardous chemicals, shipped on a 5-part manifest
What departments get involved in generating and managing pharmaceutical waste
-pharamcy -nursing -infection control -environmental services -safey -facility management -risk management -purchasing
Where is pharmaceutical waste generated
-pharmacy/satellites -patient care units -ER/OR -ICU/CCU/NICU -Oncology/hematology and other outpatient clinics -long-term care facilities -home health care services
Hazardous waste storage accumulation site
-provides a safe and secure storage area for hazardous waste while it awaits shipping -same locked area as mercuray, xylene, formaldehyde, lab chemicals -maximum storage time: 90 or 180 days based on generator status
Where are Waste Drugs going to today?
-sewer system (unused, partial IVs, including antibiotics; compounding residuses; liquids) -red infectious waste sharps containers, bags -yellow or white chemotherapy sharps containers, bage -hazardous waste containers????
How to identify waste pharmaceuticals
-some drugs have more than one trade name. The underlying chemical name, not the trade name, is regulated under RCRA -use the Chemical Abstracts Service registry numbers that can be obtained from teh Merck Index or other chemical reference and compare them to the CAS numbers in the Code of Federal Regulations --check if something is a special kind of waste
how do you clean empty containers of P-listed wastes?
-triple rinsed -the rinsate is managed as hazardous waste
black or dark blue
RCRA hazardous waste: chemicals (pharmaceuticals) defined as hazardous by USEPA
What is the RCRA?
Resource Conservation and Recovery Act of 1976
yellow or white bags
trace chemotherapy gowns, gloves, goggles, tubing, etc.
yellow or white sharps
trace chemotherapy vials
TSDF
treatment, storage, and disposal facility
What makes a waste hazardous?
wast can be hazardous because of their characteristics (ignitability, corrosivity, reactivity, toxicity) or because they are specifically listed as hazardous waste (ex. thimersal, strong acids or bases, and solvents that can ignite easily)
white with blue top
non-hazardous pharmaceutical waste (Best Management Practies)
what is the exceptsion to the rule "has not been used for its intended purpose"?
epinephrine-any epi remaining in a pen after correct administratio is not considered hazardous waste
Red-bag, red sharp
infectious, blood borne
drain
non-hazardous pharmaceutical wasate: D5W, Lactaded Ringers, Sodium Chloride
