Smarter Hazardous Waste Disposal

The surgical nurse had a substance use disorder, went to rehab for treatment and was in long-term recovery. All seemed well, but she was surrounded by temptation when she returned to work in the OR.

“Seeing wide-open medication waste containers with syringes that still had fentanyl in them was too much for her to resist,” says Kimberly New, JD, BSN, RN, founder of Diversion Specialists, a medication security consulting firm in Nashville, Tenn.

The nurse relapsed and ultimately lost her nursing license. Her method of diversion was simple: She went into trash cans and open sharps containers to retrieve discarded syringes that contained a few precious drops of fentanyl.

“People [with drug abuse problems] will go to any lengths to divert,” says Ms. New. “With the kinds of drugs, the quantities of the substances and the pace of the work in a surgical setting, you need to have a disposal device that reduces the risk of diversion close to where staff are working, so they can immediately discard controlled substances.”

Drug disposal devices that prevent diversion are much more common than they were even a couple of years ago. Some of the devices are plugged into a power source, and some need water added to them, but most operate the same way: Armed with a one-way funnel, the devices contain a carbon-based mix that absorbs contents deposited from syringes, vials and IV bags, deactivating the substances and making them non-retrievable for use. Even though the devices render substances unusable, some manufacturers add ipecac syrup to induce vomiting in the event someone breaks into the device and drinks the discarded medications.

In addition to injectable liquids, tablets, capsules and patches can be disposed in the receptacles. Ms. New says the devices can be bracketed to every anesthesia cart in your facility, so staff can conveniently squirt the medications into the devices.

Drug disposal devices are fast becoming the best practice and the gold standard for getting rid of controlled substances, and should be used in every facility, according to Ms. New. If those traces of fentanyl that led to the nurse’s downfall had been handled differently, she might still be working in the career she loved. “Staff could have squirted the leftover amount into a disposal receptacle,” says Ms. New. “The nurse would have found only empty syringes, making her ability to divert much less likely.”

It’s also important to ensure that patients properly dispose of the controlled substances they’re prescribed after surgery. Ms. New recommends that you supply patients with drug deactivation disposal pouches at discharge. The pouches, which employ carbon to render controlled substances inert, can simply be thrown into household trash.

Even though the guidelines for sharps disposal from the National Institute for Occupational Safety and Health (NIOSH) have been around for about a quarter-century (osmag.net/9XyJQs), the latest Exposure Prevention Information Network surveillance system (EPINet) data suggest that many surgery centers have a long way to go toward complying with them. The International Safety Center, a nonprofit advocacy organization dedicated to improving the safety of healthcare workers, issued a report based on 2018 data that shows 44% of sharps injuries occurred in operating and recovery rooms.

“We’re still seeing injuries happening after use and before disposal,” says Amber Mitchell, DrPH, MPH, CPH, president and executive director of the International Safety Center. “In surgical settings, that’s often related to sharps safety devices not being activated.”

More worrisome, says Ms. Mitchell, is that 25% of those who got stuck were not the original user of the sharp. “Not properly disposing of sharps is essentially passing risk down the road,” says Ms. Mitchell. “That’s impacting surgical team members who clean up after procedures, environmental services staff and linen or laundry workers.”

Ms. Mitchell says her concern is even greater in outpatient settings than in the acute-care environment because the former doesn’t have designated safety officers. She suggests using safety-engineered scalpels and blunt suture needles or avoiding sharps altogether by employing zippers, staples or adhesives to close incisions.

Another idea is to make sure sharps disposal devices are included when ordering customized supply kits. “It’s important to ask the kit manufacturer if there is an option to include the right disposal vehicle for the sharps you’re ordering,” says Ms. Mitchell.

Also, be sure sharps disposal receptacles are mounted close to where sharps are used, so staff can dispose of them immediately, and empty the containers regularly so that they don’t become overfilled, which can increase risk of injury to staff.

Several years ago, Ascension Macomb-Oakland Hospital in Madison Heights, Mich., converted from an open fluid waste management system to a direct-to-drain unit. The open system was fraught with hassles and hazards, as nurses and techs had to walk across slippery floors while carrying heavy fluid-filled canisters to the hopper, where they poured the contents down the drain while trying not get exposed to potential infectious contaminants via splash back.

Switching to a closed system eliminated all those concerns, saves time and increases staff satisfaction, says Pamela Borello-Barnett, RN, CNOR, CSSM, Ascension’s clinical nurse manager.

If you’re still using an open system, Ms. Borello-Barnett suggests assessing your facility’s needs before deciding on which type of closed system to purchase. Wall-mounted systems let staff place fluid-filled canisters into an automatic flushing system. Mobile collection units have the capacity to collect large volumes of runoff directly from the surgical site or from floor-based wicking devices. When filled, staff simply roll the unit to a fixed docking station, where the contents are automatically emptied directly into the sewer system.

Orthopedic and GYN procedures that generate large amounts of fluid are ideal for a closed system, but don’t ignore the potential benefits the systems provide in endoscopy suites. Ascension added one of the closed mobile units to the mix.

“It really has streamlined fluid collection,” says Ms. Borello-Barnett. “It’s eliminated the time-consuming process of removing disposable canisters from the OR and dumping waste into the hopper several times a day. The [high-capacity] mobile unit lasts all day, and makes overall operations much more efficient.” OSM