Safety's a terrible thing to waste

By not minding the Ps and Qs of biomedical waste disposal, hospitals could end up with blood � and lawsuits � on their hands

By Armen Tamzarian

It could happen so easily. A nurse giving an injection to a Hepatitis A patient accidentally throws the syringe in the trash instead of the designated medical waste container. Later, when the janitor is changing the garbage, the syringe pokes through and pierces his finger. One small mistake, but with huge consequences � a staff member at risk for a life-threatening illness, and the hospital will have to take the blame.

Though this scenario is fairly rare, it highlights how important it is for hospitals not just to have proper disposal guidelines on the books, but also to follow them. Unfortunately, the fact that it's rare can tend to cause some hospitals and their staff to be less than diligent when dealing with medical waste.

"I can tell you that most hospitals are very cognizant of the rules and they follow them to the letter," says Dr Mark Miller, Chair of the Infection Prevention and Control Unit at the Jewish General Hospital in Montreal and former president of the Canadian Infectious Disease Society, "but others are not abiding by these laws because it's inconvenient for them or just too expensive."

Dr Miller says that in addition to the usual suspects � mainly sharps � new and emerging issues with biomedical waste are causing concern. "More and more people are using newer mixtures of biohazard materials," he says. "It's becoming a greater problem because the current guidelines are not capable of handling this new type of waste."

WHAT A WASTE
Healthcare facilities in Canada generate a mind-boggling 500,000 tonnes of medical waste a year. According to the Guidelines for the Management of Biomedical Waste in Canada, issued in 1992 by the Canadian Council of Ministers of the Environment, human biomedical waste refers to human anatomical waste and non-anatomical waste such as tissue, vaccines, sharps, and materials saturated with blood generated by health facilities.

Health Canada's Infection Control Guidelines state that the likelihood of infection from medical waste depends on a number of factors, including the virulence of the micro-organism � some infectious disease agents, like Hepatitis A, are able to survive in the environment � and the susceptibility of the person in contact. "The guidelines on biomedical waste disposal are fine," says Dr Miller. "The surveillance, however, is very lax right now."

HOW ONE PROVINCE DEALS
Each province has its own rules for managing waste. In Quebec, the Regulation Respecting Biomedical Waste governs their disposal. The guidelines state that anatomical waste has to be treated by incineration while non-anatomical waste can either be incinerated or disinfected.

The operator managing this waste is ordered to keep a daily register of the type of biomedical waste treated, the quantity, and its source. Furthermore, waste boxes must be packed in biohazard plastic bags, labelled, and stored in a secure area. Failure to comply with these laws could put a serious dent in a hospital's pocket with fines ranging anywhere from $2,000 to $500,000.