Does This Belong in Red Bag Waste?

Waste Management

By: Mitch Birchfield

Published: 12/6/2009

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Take this quiz to find out where you can reduce your waste costs.


It's dangerous to assume, but I'm going to make 3 assumptions anyway about what gets thrown away at your facility.

  • Your ORs are your primary generators of your medical waste stream. That's safe to say.
  • You're paying about 10 times as much to dispose of medical waste as solid waste.
  • Most of the items in your medical waste containers don't belong there. Conservatively, I'm willing to bet that 60% to 70% of what gets tossed into red bags can be defined as trash or items that are either reusable or recyclable.

Medical Waste Quiz

1. Medical waste can be defined as __________ .
a. Anything contaminated by bodily fluids that is wet or dry. Most items disposed of in the surgery setting should be considered medical waste.
b. Saturated or semi-saturated items and other potentially infectious materials (OPIM).
c. Significantly contaminated waste, including grossly saturated pads, sponges, caked-on materials, contaminated syringes, needles, semi-liquid blood or other potentially infectious materials.
d. All of the above.

2. Sharps containers can _______ .
a. Accept any contaminated glass, intact vial or ampule or contaminated sharp.
b. Accept needles, broken glass and sharp objects that are contaminated or potentially contaminated with blood or OPIM.
c. Be recycled or reused (with contents rendered appropriately) by companies that collect and disinfect containers.
d. All of the above.

3. Used suction canisters are __________ .
a. Not the responsibility of most surgery staffs. Container liquids are evacuated, wiped clean, then reused.
b. Considered contaminated even when liquids have been completely evacuated, and need to be disinfected before reuse.
c. Not medical waste. Canisters are simply impervious plastics that are collected by medical waste reprocessing vendors. The plastics are then ground down to a micron-level to create more canisters or plastic materials.
d. Both "a" and "c" are correct.

4. Which statement is true about separating plastics and packaging materials?
a. It's possible to separate plastics and packaging materials. Much of this material can be recycled, but it's important that the items aren't contaminated.
b. Per federal regulations, if the materials are exposed to or potentially exposed to any contaminated materials, then this material is considered to be infectious and must be disposed of as medical waste.
c. In the OR environment, much of what we dispose of needs to be considered medical waste or infectious. Regulations as well as ethical responsibilities require us to treat these materials as medical waste.
d. None of the above.

5. Which statement is true about treating medical waste?
a. Medical waste needs to be incinerated at facilities that have permitted on-campus/on-site incinerators.
b. Most medical waste is transported to treatment facilities that flash-sterilize the materials and then grind the materials to micron-level composite materials, which are then reused or remodeled to make items such as sharps containers and other plastic packaging materials.
c. Treatment of medical waste can be done on site or by a vendor, primarily through autoclaving or sterilization processes.
d. All of the above.

6. Medical waste containers __________ .
a. Need to be red with a red biohazard symbol on the container.
b. Can be any color, but need to be lined with red bags. The contents in the containers can be compressed in order to reduce the amount of air and to condense plastics and other materials.
c. Need to be impervious to puncture, have a single red liner and have the biohazard symbol clearly visible on the outside of the container.
d. None of the above.

7. What is "dual waste?"
a. There is no such thing as dual waste.
b. Dual waste is both hazardous (contains residual hazardous drugs) and infectious.
c. Dual waste is primarily known as universal waste and may be contaminated, but is permitted for recycling.
d. Both "b" and "c" are correct.

8. Bulk chemotherapy waste is removed and incinerated by __________ .
a. Regulated medical waste haulers.
b. Universal waste haulers.
c. Hazardous waste haulers.
d. All or any of the above, since the waste is treated at the same FDA-regulated and FDA-permitted facilities.

9. Used "blue wrap" is __________ .
a. Used in the sterile field and disposed of into medical waste or trash.
b. Used for instrument wrap and is universally used in the OR.
c. A polypropylene that some plastic manufacturers can recycle into a variety of products, including park benches.
d. All of the above.

10. For most healthcare organizations, medical waste should represent what percent of the total waste stream?
a. Although there's no overall consensus or guidelines, 40% to 42% is usually the range cited.
b. About 23% to 24% of the overall waste stream.
c. 10% or less.
d. None of the above.

Only about 2% to 3% of medical waste is truly infectious waste, according to CDC estimates. Healthcare guidelines recommend that regulated medical waste should represent 10% or less of your total waste stream.

We've all evolved from the days of tossing pizza boxes into the medical container. The challenge nowadays is to refine how we segregate and dispose of medical waste. Understanding what medical waste is must be more than having an infectious waste disposal policy. It must be part of your facility's waste management plan. Take the quiz on page 67 to see where you need help in your medical waste reduction project.

If you've never audited your medical waste, the process will be enlightening and make the somewhat mundane issue of medical waste identification and reduction relevant and maybe even fun. A simple way to do this: Perform a baseline audit and then perform a post-case audit of items in the medical waste. Also review the work of between-case cleaners and terminal cleaning staff, as their ability to segregate waste is also key to successful outcomes for your medical waste reduction project.

In 2006 and 2007, we profiled our waste and recycling streams. We used a scorecard to get a baseline of each. From this scorecard, we found that of all the materials we processed, solid waste comprised about 65%, recycling about 24%, regulated medical waste about 10% and hazardous materials 1%.

If you've not done a waste audit before, you're likely to find that many items may be somewhat indiscriminately disposed of. You're also likely to discover that many items are in the medical waste because there aren't alternative containers that make it convenient for staff to dispose of trash or recycle. This is no small point. By positioning containers in the determined right locations to capture solid waste and recycle waste, our OR staff was able to divert solid waste and recycling materials from the medical waste stream. In 2008, the OR diverted 38,000 pounds of solid waste and recycling from the medical waste stream. Since the beginning of 2009, the OR team has diverted about 66,000 pounds of medical waste. This represents about $63,000 in savings.

Involve staff at different levels in the process: surgeons, nurses, support groups from the OR and cleaning staffs. Present your findings to all stakeholders. The good news is that surgical staffs are conscious of the insidious amount of waste they contend with everyday. By correctly identifying and segregating medical waste, these types of projects become an integral part of any waste management plan's goals: to reduce, reuse, reprocess and recycle materials.

Quiz Answers
1. c*; 2. b; 3. b; 4. a; 5. c; 6. c ; 7. b; 8. c; 9. d; 10. c

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