1. Hazardous Waste Regulatory Update Lisa Papetti, Environmental Engineer U.S EPA – New England RCRA Compliance Unit 617-918-1756

2. Things to think about Most small to mid-sized hospitals should be operating as at least Small Quantity Generators. However, the proper category can only be confirmed through a full chemical and waste inventory from cradle to grave. Waste identification is critical for all areas of the hospital -- train technicians in waste determination and satellite storage.

3. Things to think about Greater than 1 kg or 2.2 lbs. of acutely hazardous waste makes you a Large Quantity Generator!! Greater than 1 kg or 2.2 lbs. of acutely hazardous waste makes you a Large Quantity Generator!! P-listed wastes = acutely toxic P-listed wastes = acutely toxic

4. Things to think about Use the Universal Waste Rule, where applicable. Check web pages and ask questions of regulatory agencies, trade groups, and professional societies. Always anticipate inspections, perform self-audits, and keep records.

5. Most Common RCRA Violation in Healthcare Hazardous waste determinations Improper disposal, including chemotherapy waste Improper management of expired pharmaceuticals Open containers Unmarked/unlabeled containers Satellite accumulation Hazardous waste training Contingency plan Improper consolidation of waste from nearby facilities Note: Don’t forget contractors and consultants

6. Locations Where Wastes Can Be Found Laboratories Operating rooms Nursing units Haz. waste areas Construction Satellite acc. areas Laundry Dental clinics Maintenance X-rays units Pharmacy Morgue

7. Typical Hospital Hazardous Waste Mercury and mercury-containing items Includes whole items and spill residue Photographic/X-Ray fixer solutions Silver recovered from fixer, if not recycled

8. Typical Hospital Hazardous Waste X-Ray Film containing silver or other metals Ethanol and formaldehyde/ethanol solutions Spent, off-spec, or excess laboratory chemicals (solvents, acids, bases, etc.) Chemotherapy drugs

9. Typical Hospital Hazardous Waste Waste, excess, and off-spec paints and cleaning products Fluorescent light bulbs, if not managed as Universal Wastes - Other types include high- intensity discharge (HID), neon, mercury vapor, high pressure sodium, and metal halide lamps Batteries, if not managed as Universal Wastes

10. Typical Hospital Hazardous Waste Computers/monitors, circuit boards, and other lead-bearing electronics Lead aprons and shielding Includes all cathode ray tube (CRT) screens Compressed gases (generally, any that are ignitable) Waste pesticides, fungicides, etc.

11. Specific Hospital Hazardous Wastes Cerrobend X-ray shielding putty used to protect patients from damage to adjacent healthy tissue during irradiation of tumors and other confined areas X-ray shielding putty used to protect patients from damage to adjacent healthy tissue during irradiation of tumors and other confined areas Contains Lead and Cadmium Contains Lead and Cadmium Discarded material and shavings can be characteristic toxic HW when disposed Discarded material and shavings can be characteristic toxic HW when disposed

12. Specific Hospital Hazardous Wastes Chemotherapy Drugs Several chemotherapy drugs (antineoplastics) are listed in 40 CFR 261.33(f) (U-listed HW) Several chemotherapy drugs (antineoplastics) are listed in 40 CFR 261.33(f) (U-listed HW) Listing includes: discarded commercial chemical products, off-specification species,container residues, and spill residues Listing includes: discarded commercial chemical products, off-specification species,container residues, and spill residues

13. Specific Hospital Hazardous Wastes IV BAGS AND ASSOCIATED EQUIPMENT Empty bags and equipment that are not acutely hazardous may be disposed as empty containers Empty bags and equipment that are not acutely hazardous may be disposed as empty containers Bags and equipment with regulated material remaining must be managed as hazardous waste Bags and equipment with regulated material remaining must be managed as hazardous waste

14. Specific Hospital Hazardous Wastes Some Examples: Some Examples: – chlorambucil (U035) – cyclophosphamide (U058) – daunomycin (U059) – melphalan (U150) – mitomycin C (U010) – streptozotocin (U206) – uracil mustard (U237) - arsenic trioxide (P012!!!)

15. Specific Hospital Hazardous Wastes Mercury Containing Devices & Products In Patient Rooms Mercury Containing Devices & Products In Patient Rooms Temperature Measurement Blood Pressure Nursing Incubators Room Temperature Controllers Batteries

16. Specific Hospital Hazardous Wastes Mercury Containing Devices & Products In Storage & Maintenance Rooms Mercury Containing Devices & Products In Storage & Maintenance Rooms Antifouling agents Cleaning Chemicals Degreasers

17. Specific Hospital Hazardous Wastes Mercury Containing Devices & Products In Storage & Maintenance Rooms Mercury Containing Devices & Products In Storage & Maintenance RoomsPreservativesSolvents Outdated mercury-containing equipment Paints

18. Specific Hospital Hazardous Wastes Mercury Containing Devices & Products In Treatment & Surgery Rooms Mercury Containing Devices & Products In Treatment & Surgery RoomsMerthiolate Mercury Nitrate Mercury Iodide MercurochromeThimerosal

19. Specific Hospital Hazardous Wastes Mercury Containing Devices & Products in Treatment & Surgery Rooms Mercury Containing Devices & Products in Treatment & Surgery Rooms Esophageal Dilators Cantor Tubes Miller Abbot Tubes Feeding Tubes Dental Amalgam

20. Specific Hospital Hazardous Wastes Sodium Azide – P105 Also found in Enterococcus agars Listed in 40 CFR 261.33(e) (P-listed HW) Listing includes: discarded commercial chemical products, off-specification species, container residues, and spill residues

21. Specific Hospital Hazardous Wastes Picric Acid Picric Acid 2,4,6-trinitrophenol, picronitric acid, melinite Sometimes used in histology labs A component of Bouin’s Solution– tissue preservative Dry picric acid is explosive and disposal is very costly and disruptive

22. EPA New England’s Most Recent Enforcement Action Veterans Administration-New England Healthcare System Veterans Administration-New England Healthcare System White River Junction, VT White River Junction, VT Total Penalty = $372,254 Total Penalty = $372,254

23. EPA New England’s Most Recent Enforcement Action Violations Failure to conduct waste determination Failure to have fire suppression equipment Failure to label Failure to close containers Failure to date containers Unauthorized treatment and disposal Failure to minimize potential for release Failure to conduct hazardous waste training Universal Waste dating Failure to separate incompatibles

24. EPA –New England Compliance Assistance Janet Bowen Bowen.janet@epa.gov 617-918-1795www.epa.gov/region1/healthcare