Hazardous waste and red-bag trash

AORN Journal, May, 2008 by Bonnie Denholm

QUESTION: The nurses at our facility have requested clarification about when a sponge needs to be disposed of in a red bag. Can you explain what belongs in the red-bag trash? What is considered regulated medical waste and where should regulated medical waste be stored?

ANSWER: Whether an item should be classified as regulated medical waste is a frequently asked question. AORN's "Recommended practices for environmental cleaning in the perioperative setting" states that

   Disposable items contaminated with blood
   and/or tissue that would release blood or
   other infectious materials in a liquid or semi-liquid
   state if compressed, or items that are
   caked with dried blood or other potentially infectious
   material, must be placed in closable,
   leak-proof containers or bags that are color
   coded, labeled, or tagged for easy identification
   as biohazardous waste.... Disposable
   items that do not release blood and/or other
   infectious material in a liquid or semi-liquid
   state, if compressed, or that are not caked
   with dried blood or other potentially infectious
   materials are considered noninfectious
   and should be placed in a separate receptacle
   designated for noninfectious waste. (1(p378))

The Occupational Safety and Health Administration (OSHA) criterion is that the item is capable of releasing a substance (ie, leaving a residue) when compressed. This means that the compressed, contaminated item need only leave a smear, smudge, or dried particle on the surface to be considered regulated medical waste, which requires special handling. (2)

Other potentially infectious material should be identified as regulated medical waste depending on the above criterion. Examples include human body fluids such as semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, or any body fluid that is visibly contaminated with blood. (2)

Health care organizations should revisit these criteria and reassess contaminated items that most likely should be treated as regulated waste but are being discarded in clear plastic bags. State regulations may be more stringent than the OSHA criteria and should be consulted to clarify when it is necessary to dispose of items in a hazardous waste container. (1,2)

Storage areas for regulated medical waste should have a floor drain; exhaust ventilation; and lighting, walls, and floors that can be disinfected. The storage areas also should provide protection from insects, animals, weather, and unauthorized entry before waste transportation or disposal. (1,2)

REFERENCES

(1.) Recommended practices for environmental cleaning in the perioperative setting. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2008:375-389.

(2.) Bloodbome pathogens--1910.1030. Occupational Safety & Health Administration. http://www.osha .gov/pls/oshaweb/owadisp.show_document?ptable =STANDARDS&p_id=10051. Accessed March 9, 2008.

BONNIE DENHOLM

RN, MS, CNOR

PERIOPERATIVE NURSING SPECIALIST

AORN CENTER FOR NURSING PRACTICE