Long-term care (LTC) organizations and nursing homes produce many kinds of waste during the care and treatment of residents. In these settings, proper waste management is essential to keep people safe, protect the environment, and ensure regulatory compliance. The following sections provide information and guidance for LTC facilities and nursing homes on how to correctly segregate waste.
What Types of Waste Are Generated in a LTC Facility or Nursing Home?
Most of the waste in these facilities is non-regulated waste, meaning it’s similar to the waste produced by other businesses, such as hotels. The majority of the remaining waste falls in the category of either biomedical waste which includes non-anatomical and sharps or pharmaceutical waste. As part of the disposal process, staff must segregate waste into different containers, helping to ensure it is handled and managed appropriately according to its risks and regulations.
How to Segregate Medical Waste in LTC Facilities and Nursing Homes
Any contaminated items that could puncture the skin should be thrown away in sharps containers that are puncture-resistant in accordance with the National Standard of Canada (CAN)/CSA Standard. Applicable items may include syringes, needles, scalpels, glass vials, and so on. Designed to prevent punctures, leaks, and overfilling, these containers can reduce the chances of needlestick injuries, which can cause exposure to bloodborne pathogens.
Organizations may opt to use reusable containers as part of sharps disposal efforts. These containers are made of hard plastic that can be reprocessed and reused, which ultimately reduces the number of receptacles ending up in landfills.
Biomedical Waste – Non-anatomical (Yellow Bags)
While there is no universally accepted definition of medical waste, federal, provincial, and municipal agencies differentiate those wastes that have potential for causing harm and infection and have regulations around the collection, transportation, treatment, and disposal of them. Biomedical waste that is not a sharp belongs in a biomedical waste container lined with a yellow bag for non-anatomical waste. (Anatomical and cytotoxic waste are managed separately and are segregated in red-coded containers)
When the bag is full, staff should hand tie and knot the bag to secure it. Overfilling yellow bags can make them too heavy, which can cause them to rip or break. Wet or leaking containers will not be accepted by a waste management provider.
Personal Protective Equipment
Gowns, gloves, face masks, and other personal protective equipment (PPE) used during resident care should be treated as either regular waste or biomedical waste, depending on whether the items are contaminated with blood or potentially infectious materials (OPIM), which could contain pathogens dangerous to humans and the environment. Organizations should clearly define parameters for PPE waste segregation to ensure proper disposal of used PPE.
Pharmaceutical waste is any leftover, unused, or expired medication that is no longer needed. It can be classified as either hazardous or non-hazardous depending on its chemical properties and risks. Inconsistent drug disposal can result in dangerous chemicals leaching into the surrounding environments and contaminating groundwater, drinking water, plant life, and more.
While non-hazardous pharmaceuticals should be segregated from other biomedical waste into a container specifically designated for non-hazardous pharmaceutical waste and destined for incineration, hazardous pharmaceuticals have different waste requirements due to the increased risk to humans and the environment.
Controlled Substance Waste
Health Canada and the Office of Controlled Substances regulates controlled substances. The Controlled Drugs and Substances Act (CDSA) is the legislative framework that provides control of substances that can alter mental processes and produce harm to the health of an individual and/or society when diverted or misused. Controlled substances are regulated and grouped into Schedules I to V to the CDSA.
Because of the high risk to people and communities, the CDSA has specific disposal requirements for controlled substances to prevent diversion—when someone steals drugs to use for non-therapeutic purposes. The long-term care setting is prone to drug diversion due to the frequent use of opioids, such as oxycodone, in treating residents’ pain. Other risk factors include lax security, absence of oversight and lack of technology.
In light of the risks associated with these drugs, long-term care organizations and nursing homes should have a robust drug diversion prevention program in place, which may entail comprehensive staff training among other tactics.
What Happens if an Organization Overclassifies Waste and Treats it All as Biomedical Waste?
Organizations should treat waste that is not saturated with blood or OPIM as they normally would. Regular trash should not be overclassified as biomedical waste which can dramatically increase the costs of waste management unnecessarily. For instance, materials contaminated with certain bodily fluids, such as urine, feces, nasal secretions, sweat, spit, or vomit, are not considered biomedical waste, but without proper waste segregation, they could be disposed of incorrectly, costing the organization more money.
Why Is Staff Training on Waste Management So Important?
Staff play a key role in helping to ensure waste ends up in the right container every time. If employees are not careful about how waste is disposed of, they can inadvertently cause serious harm to themselves, their residents, and the environment. Conversely, they can increase the cost of waste management as well.
Due to these factors, it is essential for organizations to provide recurring training and education on medical waste segregation. Staff training and education should be varied to keep it fresh and compelling and include real-world applications so employees can easily apply what they learn to their day-to-day work. Online education tools can be especially valuable. Modules are continuously updated, offering the latest information, and allowing staff to complete training at their convenience. Participation is documented and can be used to demonstrate compliance.
Medical waste training should be one element in a comprehensive staff education program. Other topics to address include WHIMIS, bloodborne pathogens, and PPE training. When a long-term care organization or nursing home provides a multifaceted training program, it can go a long way toward ensuring a safe and secure environment for residents and staff.
How Stericycle Can Help with Your Long-Term Care Facility and Nursing Home Waste Disposal Needs
Stericycle can partner with your long-term care facility or nursing home to help ensure sound, compliant, and reliable waste management. Visit our medical waste solutions for more information.