1. HLD Waste Management Cytotoxic Waste Management Lab Waste Recycling Jack Rogers – MHS Safety Manager WSHSC January 28, 2011

2. HLD Waste Management  Cidex OPA OPA considered Category A toxic substance. Designates as WA State toxic Requires waste treatment prior to discharge or off- site disposal.

3. HLD Waste Management  Cidex OPA Typical in 4-8 gallon scope washers. Neutralized in adjoining sinks or in unit. Need OPA spill kits including neutralizing equipment. Adequate ventilation, PPE and Emergency wash facility

4. HLD Waste Management  Cidex OPA TBG Logs required TGH-MBH=3123 lbs ALH=1543 lbs GSH=1709 lbs BAKER ASC=2985 lbs MBCHC ASC=2452 lbs Gig Harbor ASC=1009 lbs Covington ASC=1668 lbs MD Offices=263 lbs MHS Total=14751 lbs

5. HLD Waste Management  Cidex OPA TBG Costs $3 per Gallon 1765 Gallons $5295 Off-Site Disposal 50 Gallons/ Drum 35 Drums*$400/drum $14,000

6. HLD Waste Management  Glutaraldehyde Typical in 8-12 gallon scope washers. Neutralized in adjoining sinks or in unit. Need spill kits including spill procedures in accordance established WA State Emergency Response Standard. Adequate ventilation, PPE and Emergency wash facility

7. HLD Waste Management  Glutaraldehyde Considered Category C toxic substance. Designates as WA State toxic Requires waste treatment prior to discharge or off- site disposal unless permitted by local AHJ.

8. HLD Waste Management  Glutaraldehyde TBG Logs required Covington MOB 20 Gallons 28 Day=2027 Pounds Allenmore MOB 8 Gallons 14 Day=1726 lbs MHS Total=3753 lbs

9. HLD Waste Management  Glutaraldehyde TBG Costs $3 per Gallon 449 Gallons $1347 Off-Site Disposal 50 Gallons/ Drum 9 Drums*$400/drum $3600

10. HLD Waste Management  Sterrad Plasma Systems Typical in Central Services and Surgery departments Hydrogen peroxide >50% PPE and Emergency wash facility D001, D002 Waste Codes

11. HLD Waste Management  Steris Systems Typical in Central Services and Surgery departments Recently received FDA approval back as System 1E Peracetic acid 35% PPE and Emergency wash facility D001, D002 Waste Codes

12. Case Study – Bladder Cancer Treatment Waste Management  Treatment of bladder cancer in urology physician offices as well as surgery includes hazardous drugs.  BCG  Mitomycin U listed cytotoxic agent

13. Case Study – Bladder Cancer Treatment Waste Management  Employees treating all wastes as trace chemotherapy including  Biohazardous - BCG  Mitomycin U listed cytotoxic agent  Question: What to do with urine contaminated with cytotoxic agent (bulk waste)?

14. Case Study – Bladder Cancer Treatment Waste Management  Bulk Chemotherapy – Send to RCRA approved incinerator – No sharps  Trace Chemotherapy – Sent to Stericycle municipal waste incinerator, including sharps, gowns, gloves, empty bags, tubing.  Question: What to do with urine contaminated with cytotoxic agent (mixed bulk waste)?

15. Case Study – Bladder Cancer Treatment Waste Management  Operating rooms – Procedures instillation of Mitomycin in bladder. Removed in recovery area.  First had staff empty urine/mitomycin in hopper sink  Developed a mixed waste profile for Mitomycin and urine. Will be incinerated at RCRA approved incinerator.

16. Case Study – Bladder Cancer Treatment Waste Management  DOSH complaint and compliance inspection with respect to the bladder procedure  Complaint originated from recovery and surrounded employees not certified in chemotherapy handling.

17. Case Study – Bladder Cancer Treatment Waste Management  Findings by DOSH  Nurses (two involved recovery of these patients) had been medical oncology RN in past.  Certification not required but competent to their jobs involving chemotherapy  All employees involved in these procedures need to be competent.  We were criticized but didn’t receive a citation for our practices but probably would have if a regulation existed.

18. Case Study – Bladder Cancer Treatment Waste Management  Findings by DOSH  General citation received for not updating Exposure Program annually.  DOSH compliance officer indicated public hearings on this subject soon.

19. Case Study - Lab Waste Management Recycling  Solvents  Xylene 480 Gallons-3500 lbs/year  Alcohol 380 Gallons-2500 lbs/year Question: Need to reduce waste and reuse product?

20. Case Study - Lab Waste Management Recycling  CBG Biotechnologies  Recycles Xylene and Alcohol both  Still bottoms into waste poly containers for disposal.  Costs $25K

21. Case Study - Lab Waste Management Recycling  Cost Benefit  Xylene R 480 Gallons-3500 lbs/year D 130 Gallons-930 lbs/year Saved 2570 Lbs Waste  Alcohol R 380 Gallons-2500 lbs/year D 130 Gallons-850 lbs/year Saved 1650 Lbs Waste Other savings – Pollution prevention, product costs, waste generation

22. Case Study - Lab Waste Management Recycling  Formalin  WA State Toxic  Requires treatment by generator or off-site disposal  580 Gallons=4850 Lbs Per Year Question: Need to reduce waste and reuse product?

23. Case Study - Lab Waste Management Recycling  CBG Biotechnologies  Recycles formalin  Still bottoms into waste poly containers for TBG.  Costs $25K

24. Case Study - Lab Waste Management Recycling  Cost Benefit R 580 Gallons-4850 lbs/year D 159 Gallons-1330 lbs/year Saved 3520 Lbs Waste 73% 159 gallons neutralized = $640 Other savings – Pollution prevention, product costs, waste generation

25. Jack Rogers253-403-2084 Safety Manager/Acute Care Safety Officer Don Balzarini253-403-9168 Ambulatory Safety Officer Phil Amundson253-403-2070 MHS Industrial Hygienist Tom Armstrong 253-697-2269 Good Samaritan Safety Coordinator MHS Safety Contacts