1. Disposal of Biomedical Wastes

2. Biomedical Waste Presents a Serious Health Problem Risks Include: Outright Injury to Workers Outright Injury to Workers Exposure to Infectious Agents Exposure to Infectious Agents Psychological Trauma Regulatory Actions Legal Actions Environmental Issues The Risks involve: Medical Staff Healthcare Workers Maintenance and Housekeeping Staff Disposal Company Staff Landfill Employees Innocent and Unaware Public (Kids)

3. Some Facts from CDC Sharps Sharps 385,000 needlesticks and other sharps-related injuries are sustained by hospital-based healthcare personnel; an average of 1,000 sharps injuries per day Direct costs associated with the initial and follow-up treatment of exposed healthcare personnel, which are estimated to range from $500 to $3,000 depending on the treatment provided Biomedical Waste Every year, the United States produces approximately 3.2 million tons of medical waste, which includes blood and human waste, used needles and other "sharps," pathological and infectious wastes, "isolation" waste (i.e. waste that could spread highly communicable diseases) and some cytotoxic waste (i.e. chemotherapy byproducts).

4. Some Facts from Okanogan County The Okanogan County Sanitary Landfill has been seeing 3 to 5 incidents of illegal Biomedical Waste Disposal per week. The reports forwarded to Okanogan Public Health by the Landfill have not been “gray area” violations, but clear and flagrant violations. In addition to violation of local and state regulations on biomedical waste, there have clear violations of HIPAA confidentiality and security regulations (photo documented)

6. 4/8/2005: Unshredded medical records, bloody sponges, gauze, gloves biohazard bag, bloody drapes sponges contained in black plastic bag biohazard bag, bloody drapes sponges contained in black plastic bag Consequence: Entire 15,700 pound load was treated as biomedical waste 4/1/2005: Biohazard bags in dumpster with regular garbage Bags with blood gauze, mouth swabs etc 3/31/2005: Bloody Plastic tubes, drapes and trays C-section materials February 15, 2005: Okanogan County Public Health Mailed out Letters to offending waste generators Continued improper disposal places not only the health of workers at risk but also the continued operation of disposal companies and landfill. Public Health, the county landfill and the disposal companies are running out of options. November 2006 : Okanogan County Adopted a Biomedical Waste Code with significant penalties and fees: 1 st Offense: $ 125 + clean up fees 2 nd Offense: $1,000 + clean up fees 3 rd Offense: $4,000 + clean up fees 4 th Offense: $10,000 + loss of disposal privileges

7. Local, State and Federal Regulations Require: Biomedical Waste must be Segregated from regular Domestic Waste at the Site of Origin or Generation The Okanogan County Landfill receives 3 to 5 cases per week of mixed domestic and biomedical waste

8. Local, State and Federal Regulations governing Waste Disposal Companies require: Specialized containers and Handling procedures for Biomedical Waste It is Illegal for Waste Disposal Companies to carry mixed or un-segregated Domestic Waste and Biomedical Waste It is illegal to compress or compact Biomedical Waste Disposal companies can be fined and/or lose their operating permits for violations of these regulations Disposal Companies can refuse to accept mixed wastes

9. Biomedical waste" means solid waste of the following types: (a) "Animal waste," which includes waste animal carcasses, body parts, and bedding of animals that were known to have been deliberately infected or inoculated with human pathogenic microorganisms during research. (b) "Liquid human body fluids" means waste that includes waste liquid emanating or derived from humans including but not limited to human blood and blood products, serum and plasma, sputum, drainage secretions, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid and amniotic fluid that exceeds fifty milliliters per container, storage vessel, or plastic bag and cannot be and has not been directly discarded into a sanitary sewage system. (c) "Cultures and stocks" means waste that includes waste cultures and stocks of microbiological agents infectious to humans, human serums and discarded live and attenuated vaccines infectious to humans, human blood specimens, and laboratory wastes that are contaminated with these agents or specimens. (d) "Biosafety level 4 disease waste," which includes wastes contaminated with blood, excretions, exudates, or secretions from humans or animals who are isolated to protect others from highly communicable infectious diseases that are identified as viruses assigned to Biosafety Level 4 by the Centers for Disease Control, National Institute of Health, Biosafety 2) "Biomedical waste" means solid waste of the following types: (a) "Animal waste," which includes waste animal carcasses, body parts, and bedding of animals that were known to have been deliberately infected or inoculated with human pathogenic microorganisms during research. (b) "Liquid human body fluids" means waste that includes waste liquid emanating or derived from humans including but not limited to human blood and blood products, serum and plasma, sputum, drainage secretions, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid and amniotic fluid that exceeds fifty milliliters per container, storage vessel, or plastic bag and cannot be and has not been directly discarded into a sanitary sewage system. (c) "Cultures and stocks" means waste that includes waste cultures and stocks of microbiological agents infectious to humans, human serums and discarded live and attenuated vaccines infectious to humans, human blood specimens, and laboratory wastes that are contaminated with these agents or specimens. (d) "Biosafety level 4 disease waste," which includes wastes contaminated with blood, excretions, exudates, or secretions from humans or animals who are isolated to protect others from highly communicable infectious diseases that are identified as viruses assigned to Biosafety Level 4 by the Centers for Disease Control, National Institute of Health, Biosafety (e) "Pathological waste," which includes waste human source biopsy materials, tissues, and anatomical parts that emanate from surgery, obstetrical procedures, autopsy, and laboratory procedures. "Pathological waste" does not include teeth or formaldehyde or other preservative agents, human corpses, remains, and anatomical parts that are intended for interment or cremation. Regulatory Definitions of Biomedical Wastes

10. Sharps Waste "Sharps waste," which includes waste hypodermic needles, syringes, IV tubing with needles attached, scalpel blades, and lancets that have been used in animal or human patient care or treatment in medical research. E. Sharps shall be contained for storage, transportation, treatment, and disposal in leak-proof, rigid, puncture-resistant containers which are taped closed or tightly lidded to preclude content loss.

11. 8.62.040Infectious waste segregation requirements for generators. Under no circumstances shall infectious waste generated from within Okanogan County be mixed or placed with other solid waste for storage or transfer when said solid waste is destined for treatment and/or disposal in a facility requiring segregation of infectious waste. A.Infectious waste generated or received in Okanogan County shall not be mixed or placed with other solid waste for storage or transfer when such solid waste is destined for treatment and/or disposal in a facility requiring segregation of infectious waste. B. Infectious waste shall be segregated from other solid waste at the point of origin in the generating facility and managed by persons trained in the safe handling of infectious waste. Okanogan County Code

12. Basic Rules Biohazard or Biomedical Waste must be separated from “normal 1. Biohazard or Biomedical Waste must be separated from “normal domestic waste” 2. Separation of waste is the responsibility of the waste generator at the point of origin. 3. Waste in Biohazard or Orange Bags is considered Infectious by default. 4. The disposal company or transporter can refuse to pick up mixed waste. Regulations obligate him to refuse. By county, state regulations Biomedical waste cannot be compacted and there are relatively strict regulations regarding the transport of biomedical waste. 5.Personnel handling biomedical waste are required to have appropriate protection. Biomedical Waste

13. Consequences of Noncompliance: Fines to Health Care Provider or Agency Regulatory Actions: Loss of Disposal Rights Loss of Licenses Loss of Licenses Legal Claims or Lawsuits by injured parties

14. Basic Precautions Don’t Mix Orange or Biohazard Marked Bags or Materials with normal waste Don’t put normal waste or papers in Biohazard Bags When in Doubt check with your Supervisor If there are questions or concerns on the shipment of Biomedical Materials Sharps represent the most significant threat: Use proper disposal Please contact: 1) Okanogan County Landfill 2) The Waste Disposal Company 3) Okanogan County Public Health

15. Resources for Biomedical Waste Issues

16. Contact Information Okanogan County Landfill LANDFILL AND TRANSFER STATIONS Central Landfill – Okanogan: 422-2602 Central Landfill – Okanogan: 422-2602 Open Tuesday- Saturday 9am-5pm Open Tuesday- Saturday 9am-5pm Bridgeport Bar Transfer Station: 686-4242 Twisp Transfer Station: 997-2025 Open Tues, Thurs; 12-4pm, Sat. 9am-4pm Open Tues, Thurs; 12-4pm, Sat. 9am-4pm Ellisforde Transfer Station 476-3910 Okanogan County Public Health 1234 South Second Avenue in Okanogan, Washington. Phone: 509-422-7140 Fax: 509-422-7142 Mailing Address: PO Box 231, Okanogan, WA 98840 Biomedical Waste Disposal Contractor Stericycle Erik Jacobson 800-633-9278ejacobson@stericycle.com

17. Sharps Disposal for Private Citizens Okanogan County Public Works Maintains Drop-Off Stations at the following locations Okanogan County Central Landfill Bridgeport Bar Transfer Station Ellisforde Transfer Station Twisp Transfer Station Omak: Ulrich Drug Okanogan: J&S Drug Tonasket: Roy’s Pharmacy Brewster: Brewster Drug

18. Regulations and Educational Resources Okanogan County Biomedical Waste Code Okanogan County Biomedical Waste Code Washington State Regulations Washington State Regulations WAC 296-62-08001 Bloodborne Pathogens WAC 296-62-08001 Bloodborne Pathogens WAC 173-300-020 WAC 173-300-020 Washington State Mercury Chemical Action Plan (Almalagm) Washington State Mercury Chemical Action Plan (Almalagm) Centers for Disease Control Centers for Disease Control General Laboratory Safety General Laboratory Safety Workbook for a Sharps Injury Prevention Program Workbook for a Sharps Injury Prevention Program Biosafety in Biomedical Laboratories Biosafety in Biomedical Laboratories World Health Organization World Health Organization Wastes from Health-care activities Wastes from Health-care activities The Nightingale Institute The Nightingale Institute Recommendations for Improving Medical Waste Management Recommendations for Improving Medical Waste Management FAQ Click on Links