How do I dispose of medical waste

Medical waste disposal: when waste isn't just rubbish

Which containers are still suitable for needles and syringes, who can provide information about hazardous waste and how does the garbage can in a doctor's practice have to be secured? The disposal of waste in clinics and practices is well regulated. Experts therefore warn against resorting to self-made solutions.

Everything that causes cuts or stab wounds belongs in safe containers and must not be temporarily stored or refilled. Photo: xixinxing / stock.adobe.com

With seven to eight tons of waste per day, hospitals are the fifth largest waste producer in Germany. On average, around six kilos per patient are accrued every day. For comparison: the average person in this country weighs 1.7 kilos, and that is a top figure in Europe. Waste in hospitals and in private practice is subject to the guidelines of the Federal / State Working Group on Waste (LAGA). It regulates the proper disposal of waste from health service facilities and applies to all institutions and practices that take part in human or veterinary care. It has been revised and published several times, most recently in 2015 (box).

When it comes to the specific disposal of medical waste, the main aim is to avoid injuries from sharp, pointed objects and infections of other patients, staff and also the waste disposer. In the US, it is estimated that 11,700 to 45,300 needlestick injuries occur annually among clinical cleaners alone. In addition, correct waste disposal of certain substances, such as cytostatics, prevents pollution of the environment. The disposal of radioactive and genetically modified substances and animal carcasses, for which there are separate regulations, is excluded from the LAGA regulations.

Better to ask the municipality

The core of the LAGA guideline is the waste code (AS). It replaces the old ABCDE rule, which many still use - there are still equivalents. In addition, numerous other regulations play a role, from the local recycling law to the transnational European waste directory. Above all, community-specific waste law regulations, which differ from one community to the next, must be observed - not least with regard to the amount of the fines, which can be in the five-digit range.

Such regulations can be obtained from the municipalities and districts. Dr. med. vet. Nina Parohl, a doctor at HyKoMed-GmbH in Dortmund, also decidedly on her regular advanced training lectures on correct waste disposal: "Sometimes participants suggest that you don't want to know exactly, but that's not a recommended strategy," says the expert and recommends: “What is to be disposed of and, if in doubt, can be disposed of with the residual waste, that should definitely be clarified with the local waste disposal company.” Mostly it is so that the practice that is already practiced corresponds to the officially valid one. For the practice operator, this means that after clarification, he is on the safe side.

Syringes, cannulas, scalpels, lancets and everything that can cause cuts or stab wounds should be kept in safe containers; they must not be temporarily stored or refilled (AS 18 01 01 / B of the old LAGA list). It is crucial that these do not open when a cannula is stripped off, for example, and not even if such a container falls during transport.

"Anyone who wants to use old canisters in which something else was delivered for this purpose must be sure that they will not burst if they fall and that they are actually puncture-proof," explains Parohl. She also warns against too great a consciousness of savings on the part of clinic employees, which you will witness during inspections. Some still think that such containers can be “refilled” in order to save space. "But in this case that is an absolute no-go," says the expert. Objects that are contaminated with notifiable pathogens fall under AS 18 01 03 (old C), depending on their infectivity, the risk of transmission or the extent and type of contamination. This also includes infectious body parts or organs, but also a scalpel. They are transported in specially marked containers and disposed of in approved incineration plants.

For waste such as disposable clothing, plaster casts, wound dressings, linen or diapers that are not pointed, sharp and also not infectious (AS 18 01 04 or B), however, securely closable plastic bags that are also tear-resistant and opaque are sufficient. Together with the safe containers for the syringes, these can usually be disposed of with normal residual waste. However, for a doctor's office or hospital, this is not as trivial as it sounds. "Some doctors do not know that the garbage cans in which they dispose of containers with sharp waste or other residual waste cannot simply be in a backyard," warns Parohl. Either the bins have to be lockable or they belong in a not freely accessible room or in a locked lattice crate, where they are protected from access by third parties.

Cytostatics, blood and body parts

Anyone who has to dispose of cytostatics may dispose of containers or infusion systems that do not contain more than 20 milliliters of residual substance in the non-infectious waste (AS 18 01 04). The same applies to swabs or disposable gloves that are slightly contaminated with cytotoxic drugs. Larger quantities, however, fall under 18 01 08 (D according to the old list) and must be disposed of in a separate container or bin labeled as hazardous waste. The obligation to keep a register and to provide corresponding evidence from the disposal company must also be observed here. Separate rules apply to medicinal products, depending on the quantity and the municipality. Small quantities can be disposed of with residual waste, larger quantities may be taken by municipal recycling centers.

Blood and blood products, but also body parts and organs, must be disposed of separately and must not be mixed with other waste (AS 18 01 02, formerly Category E). Attention should be paid to gas formation. Disposal (incineration plant or special waste incineration) should therefore take place as quickly as possible. Cool storage extends the intervals.

Disposal plan template

These are the most important disposal regulations, but by no means all. There is also garbage that does not need special treatment: paper, plastic, packaging, etc. These may - after the usual separation - in the household waste, with the exception of patient files.

Not only Parohl recommends drawing up waste disposal plans in view of the large number of variants in order to get a better overview. Templates from the National Association of Statutory Health Insurance Physicians are used for this purpose (box). Hospitals and clinics with more than 800 beds have to follow
§ 54 of the Recycling and Waste Act, appoint a full-time company representative for waste in writing and notify the competent authority of this. If you don't have to, but still want to outsource, you can fall back on commercial providers. "But", says Parohl, "here hospitals and residents alike have to find out that such a provider also has the necessary qualifications."

Last but not least, waste is also subject to hygiene regulations, according to Parohl: "The bags from an MRSA room must of course be properly cleaned before they are disposed of in the ward corridor." the operating room. Not only rubbish, rubbish bins are not clean either.

Dr. med. Martina Lenzen-Schulte

Information, links and literature

  • LAGA - waste categories according to European encryption

Communication from the Federal / State Working Group on Waste (LAGA) 18. Implementation aid for the disposal of waste from health service facilities

http://daebl.de/HP14

Template of the Competence Center Hygiene and Medical Devices of the Association of Statutory Health Insurance Physicians and the National Association of Statutory Health Insurance Physicians

http://daebl.de/SQ64

Since 2010, the hazardous waste according to the LAGA-AS key has to be specially marked (only via the electronic waste record procedure)

http://www.eanv-information.de/

From amalgam to zika - explanations from the commercial supplier Remondis-Medison

http://daebl.de/RQ85

  • Waste codes that often arise for specialist areas

For example for dialysis, oncology, pathology, urology

http://daebl.de/AE17

  • Working groups of the federal states on environmental protection in hospitals

http://daebl.de/SV37

  • Sample instructions for the packaging of infectious waste (M 305)

Checklist of the Robert Koch Institute (UN 2814)

http://daebl.de/EH51

  • Further reading Popp, et al .: Waste disposal in hospitals. Bundesgesundheitsbl 2009; 52: 753-63.